国际呼吸杂志
國際呼吸雜誌
국제호흡잡지
International Journal of Respiration
2015年
16期
1219-1225
,共7页
梁毅林%郑厚文%陈乐城%姚伦凯%黎雨%谭小玉%柳广南
樑毅林%鄭厚文%陳樂城%姚倫凱%黎雨%譚小玉%柳廣南
량의림%정후문%진악성%요륜개%려우%담소옥%류엄남
良性气管狭窄%气管球囊扩张成形术%纤维支气管镜%通气管
良性氣管狹窄%氣管毬囊擴張成形術%纖維支氣管鏡%通氣管
량성기관협착%기관구낭확장성형술%섬유지기관경%통기관
Benign tracheal stenosis%Balloon dilatation%Bronchoscopy%Tube
目的 比较通气管辅助下与常规方法纤维支气管镜气管球囊扩张成形术治疗良性气管狭窄的疗效及安全性.方法 对2009年8月至2013年12月因不同病因致良性气管狭窄收住广西医科大学第一附属医院呼吸内科的49例患者按首诊日期随机分为A、B两组,分别采用常规方法纤维支气管镜气管球囊扩张成形术和通气管辅助下纤维支气管镜气管球囊扩张成形术治疗.并测量术前、术后狭窄段气管内径、气促评分,检测球囊扩张成形术术前、术中、术后血气分析,监测操作过程中脉搏氧饱和度;评价疗效和并发症发生情况.结果 A组22例患者进行了48次常规方法纤维支气管镜气管球囊扩张成形术治疗,B组27例患者进行了54次通气管辅助下纤维支气管镜气管球囊扩张成形术治疗.A、B两组患者治疗后呼吸困难症状均立即缓解,狭窄段气管内径分别由(5.61±1.21) mm增加到(12.06±1.17) mm(t=-29.759,P＜0.001),由(5.68±1.53) mm增加到(12.88±1.36) mm(t=-30.927,P＜0.001);气促评分分别由3.44±0.85下降到0.52±0.62(t=20.065,P＜0.001),由3.43±0.84下降到0.48±0.57(t=25.278,P＜0.001).术前、术中、术后血气分析检测结果PaO2、PaCO2变化分别为:A组:(98.13±24.59) mmHg、(84.73±17.62) mmHg、(97.22±21.21) mmHg(F=6.255,P=0.003)和(45.91±7.01) mmHg、(46.98±6.68) mmHg、(41.06±4.62) mmHg(F =12.616,P＜0.001);B组:(101.38±27.26) mmHg、(99.55±30.70) mmHg、(98.61±22.07) mmHg(F=0.176,P=0.839)和(43.64±3.96) mmHg、(49.99±6.81) mmHg、(40.01±3.51) mmHg(F =53.231,P＜0.001).两组即时有效率均为100.0％;在经过1～4次纤维支气管镜气管球囊扩张成形术治疗后,A组、B组分别有59.1％和85.2％的患者在1个随访周期内症状维持缓解(x2=4.235,P=0.040).结论 通气管辅助下纤维支气管镜气管球囊扩张成形术治疗良性气管狭窄比常规方法具有更高的安全性和长期疗效,但需密切注意其CO2潴留可能产生的不良影响.
目的 比較通氣管輔助下與常規方法纖維支氣管鏡氣管毬囊擴張成形術治療良性氣管狹窄的療效及安全性.方法 對2009年8月至2013年12月因不同病因緻良性氣管狹窄收住廣西醫科大學第一附屬醫院呼吸內科的49例患者按首診日期隨機分為A、B兩組,分彆採用常規方法纖維支氣管鏡氣管毬囊擴張成形術和通氣管輔助下纖維支氣管鏡氣管毬囊擴張成形術治療.併測量術前、術後狹窄段氣管內徑、氣促評分,檢測毬囊擴張成形術術前、術中、術後血氣分析,鑑測操作過程中脈搏氧飽和度;評價療效和併髮癥髮生情況.結果 A組22例患者進行瞭48次常規方法纖維支氣管鏡氣管毬囊擴張成形術治療,B組27例患者進行瞭54次通氣管輔助下纖維支氣管鏡氣管毬囊擴張成形術治療.A、B兩組患者治療後呼吸睏難癥狀均立即緩解,狹窄段氣管內徑分彆由(5.61±1.21) mm增加到(12.06±1.17) mm(t=-29.759,P＜0.001),由(5.68±1.53) mm增加到(12.88±1.36) mm(t=-30.927,P＜0.001);氣促評分分彆由3.44±0.85下降到0.52±0.62(t=20.065,P＜0.001),由3.43±0.84下降到0.48±0.57(t=25.278,P＜0.001).術前、術中、術後血氣分析檢測結果PaO2、PaCO2變化分彆為:A組:(98.13±24.59) mmHg、(84.73±17.62) mmHg、(97.22±21.21) mmHg(F=6.255,P=0.003)和(45.91±7.01) mmHg、(46.98±6.68) mmHg、(41.06±4.62) mmHg(F =12.616,P＜0.001);B組:(101.38±27.26) mmHg、(99.55±30.70) mmHg、(98.61±22.07) mmHg(F=0.176,P=0.839)和(43.64±3.96) mmHg、(49.99±6.81) mmHg、(40.01±3.51) mmHg(F =53.231,P＜0.001).兩組即時有效率均為100.0％;在經過1～4次纖維支氣管鏡氣管毬囊擴張成形術治療後,A組、B組分彆有59.1％和85.2％的患者在1箇隨訪週期內癥狀維持緩解(x2=4.235,P=0.040).結論 通氣管輔助下纖維支氣管鏡氣管毬囊擴張成形術治療良性氣管狹窄比常規方法具有更高的安全性和長期療效,但需密切註意其CO2潴留可能產生的不良影響.
목적 비교통기관보조하여상규방법섬유지기관경기관구낭확장성형술치료량성기관협착적료효급안전성.방법 대2009년8월지2013년12월인불동병인치량성기관협착수주엄서의과대학제일부속의원호흡내과적49례환자안수진일기수궤분위A、B량조,분별채용상규방법섬유지기관경기관구낭확장성형술화통기관보조하섬유지기관경기관구낭확장성형술치료.병측량술전、술후협착단기관내경、기촉평분,검측구낭확장성형술술전、술중、술후혈기분석,감측조작과정중맥박양포화도;평개료효화병발증발생정황.결과 A조22례환자진행료48차상규방법섬유지기관경기관구낭확장성형술치료,B조27례환자진행료54차통기관보조하섬유지기관경기관구낭확장성형술치료.A、B량조환자치료후호흡곤난증상균립즉완해,협착단기관내경분별유(5.61±1.21) mm증가도(12.06±1.17) mm(t=-29.759,P＜0.001),유(5.68±1.53) mm증가도(12.88±1.36) mm(t=-30.927,P＜0.001);기촉평분분별유3.44±0.85하강도0.52±0.62(t=20.065,P＜0.001),유3.43±0.84하강도0.48±0.57(t=25.278,P＜0.001).술전、술중、술후혈기분석검측결과PaO2、PaCO2변화분별위:A조:(98.13±24.59) mmHg、(84.73±17.62) mmHg、(97.22±21.21) mmHg(F=6.255,P=0.003)화(45.91±7.01) mmHg、(46.98±6.68) mmHg、(41.06±4.62) mmHg(F =12.616,P＜0.001);B조:(101.38±27.26) mmHg、(99.55±30.70) mmHg、(98.61±22.07) mmHg(F=0.176,P=0.839)화(43.64±3.96) mmHg、(49.99±6.81) mmHg、(40.01±3.51) mmHg(F =53.231,P＜0.001).량조즉시유효솔균위100.0％;재경과1～4차섬유지기관경기관구낭확장성형술치료후,A조、B조분별유59.1％화85.2％적환자재1개수방주기내증상유지완해(x2=4.235,P=0.040).결론 통기관보조하섬유지기관경기관구낭확장성형술치료량성기관협착비상규방법구유경고적안전성화장기료효,단수밀절주의기CO2저류가능산생적불량영향.
Objective To compare the efficacy and safety of small-diameter tube-assisted bronchoscopic balloon dilatation and the conventional bronchoscopic balloon dilatation in the management of benign tracheal stenosis.Methods Forty-nine patients with benign tracheal stenosis were randomly divided into two groups according to the date of diagnosis.The patients in the group A were treated with conventional bronchoscopic balloon dilatation and the patients in the group B were treated with small-diameter tube-assisted bronchoscopic balloon dilatation.The tracheal diameter,dyspnea index,blood gas analysis results,pulmonary function,efficacy and complications were evaluated before,during,and after the bronchoscopic balloon dilatation procedure.Results 48 times of conventional bronchoscopic balloon dilatation procedures were performed in 22 patients in group A,and 54 times of small-diameter tube-assisted bronchoscopic balloon dilatation procedures were performed in 27 patients in group B.Dyspnea in all patients was immediately improved after bronchoscopic balloon dilatation.In group A,the tracheal diameter remarkably increased from (5.61 ± 1.21) mm to (12.06 ± 1.17) mm (t =-29.759,P ＜ 0.001),the dyspnea index showed significant decrease from 3.44±0.85 to 0.52±0.62 (t =20.065,P ＜ 0.001),PaO2 in procedure was followed as:before the operation (98.13 ± 24.59) mmHg,during the operation (84.73±17.62) mmHg,after the operation (97.22±21.21) mmHg (F =6.255,P =0.003),and PaCO2 was followed as:before the operation (45.91 ± 7.01)mm Hg,during the operation (46.98 ± 6.68) mmHg,after the operation (41.06 ± 4.62) mmHg (F =12.616,P ＜0.001).In group B,the tracheal diameter remarkably increased from (5.68± 1.53) mm to (12.88 ±1.36) mm (t =-30.927,P ＜ 0.001),the dyspnea index showed significant decrease from 3.43±0.84 to 0.48±0.57 (t =25.278,P ＜ 0.001),PaO2 was followed as:before the operation (101.38±27.26) mmHg,during the operation (99.55 ± 30.70) mmHg,after the operation (98.61 ± 22.07) mmHg (F =0.176,P =0.839),and PaCO2 was followed as:before the operation (43.64 ± 3.96) mmHg,during the operation (49.99 ± 6.81) mmHg,after the operation (40.01±3.51) mmHg (F =53.231,P ＜0.001).The immediate efficacy rates in two groups were both 100.0％,and after 1-4 procedures,the symptoms constantly relieved in 59.1％ of patients in group A and in 85.2％ of patients in group B during a follow-up period (x2 =4.235,P =0.040).Conclusions Small-diameter tube-assisted bronchoscopic balloon dilatation has higher safty and long-term efficacy than conventional method for the management of benign tracheal stenosis.However,operators must pay close attention to the adverse effects caused by carbon dioxide retention.
