支气管镜介入技术在气管支气管结核所致中叶综合征治疗中的价值

doi:10.3969/j.issn.1000-6621.2019.05.006

摘要/Abstract

摘要：

目的探讨支气管镜介入技术在气管支气管结核所致中叶综合征治疗中的应用价值。方法回顾性分析2015年11月至2017年12月解放军总医院第八医学中心全军结核病研究所确诊的全部气管支气管结核所致中叶综合征118例患者的临床资料,根据是否接受支气管镜介入治疗分为观察组(82例)和对照组(36例),对118例患者的临床症状、影像学表现、支气管镜下表现、气促评级、治疗效果进行对比分析。结果观察组和对照组患者出院后6个月时的气促评级分别为(0.74±0.12)和(1.36±0.07),差异有统计学意义(t=2.791,P=0.006)。观察组患者治疗后的总有效率为80.5%(66/82),对照组患者治疗后的总有效率为61.1%(22/36),两组患者治疗疗效比较差异有统计学意义(χ ²=12.743,P=0.002)。结论支气管镜介入技术可提高气管支气管结核所致中叶综合征治疗的有效率,是治疗气管支气管结核所致中叶综合征的重要手段。

关键词: 结核, 气管疾病, 中叶综合征, 支气管镜检查, 综合疗法, 疗效比较研究

Abstract:

Objective To investigate the application value of interventional bronchosopic techniques in treating the middle lobe syndrome due to tracheobronchial tuberculosis.Methods The date of 118 cases who were diagnosed the middle lobe syndrome due to tracheobronchial tuberculosis from November 2015 to December 2017 in the 8th Medical Center of Chinese PLA General hospital were analyzed retrospectively. The patients were divided into discovery group (n=82) and control group (n=36) by different treatment schedules. The asymptomatic, imaging appearances, bronchoscopy, ratings of short breath and effects of treatment were compared between the two groups.Results The ratings of short breath at 6 months after discharge in the discovery group and control group was (0.74±0.12) and (1.36±0.07), respectively, and the difference was statistically significant (t=2.791,P=0.006). The overall effective rate in the two groups was 80.5% (66/82) and 61.1% (22/36), respectively, and the difference was statistically significant (χ ²=12.743, P= 0.002). Conclusion The interventional bronchoscopic technique is an important treatment of patients with middle lobe syndrome due to tracheobronchial tuberculosis, and can improve the effective rate.

Key words: Tuberculosis, Tracheal diseases, Middle lobe syndrome, Bronchoscopy, Combined modality therapy, Comparative effectiveness research

石倩,王蓉蓉,张广宇,陈志. 支气管镜介入技术在气管支气管结核所致中叶综合征治疗中的价值[J]. 中国防痨杂志, 2019, 41(5): 494-498. doi: 10.3969/j.issn.1000-6621.2019.05.006

Qian SHI,Rong-rong WANG,Guang-yu ZHANG,Zhi CHEN. The application value of interventional bronchosopic techniques in treating the middle lobe syndrome due to tracheobronchial tuberculosis[J]. Chinese Journal of Antituberculosis, 2019, 41(5): 494-498. doi: 10.3969/j.issn.1000-6621.2019.05.006

图/表 4

表1

各类临床特征在两组患者中的分布情况

临床特征	观察组(82例)	对照组(36组)	统计学检验值	P值
性别[例(构成比,%)]			χ²=0.465	0.495
男	28(34.1)	10(27.8)
女	54(65.9)	26(72.2)
年龄(岁, $x ˉ$ ±s)	47.15±15.34	48.17±16.09	t=1.002	0.316
初复治[例(构成比,%)]			χ²=0.437	0.508
初治	68(82.9)	28(77.8)
复治	14(17.1)	8(22.2)
临床症状[例(发生率,%)]
咳嗽	72(87.8)	36(100.0)	χ²=3.357	0.067
咳痰	62(75.6)	31(86.1)	χ²=1.652	0.199
发热	36(43.9)	12(33.3)	χ²=1.158	0.282
胸闷	20(24.4)	9(25.0)	χ²=0.005	0.944
胸痛	10(12.2)	2(5.6)	χ²=0.590	0.442
气短	16(19.5)	4(11.1)	χ²=1.254	0.263
乏力盗汗	8(9.8)	5(13.9)	χ²=0.116	0.733
咯血	12(14.6)	4(11.1)	χ²=0.050	0.824
无明显症状	3(3.7)	1(2.8)	χ²=0.000	1.000
病变部位[例(构成比,%)]			χ²=0.065	0.799
中叶	62(75.6)	28(77.8)
舌叶	20(24.4)	8(22.2)
CT表现[例(发生率,%)]
高密度斑片状影	48(58.5)	22(61.1)	χ²=0.069	0.793
实变影	20(24.4)	11(30.6)	χ²=0.491	0.484
肺不张或充气不全	22(26.9)	8(22.2)	χ²=0.280	0.597
支气管狭窄	20(24.4)	10(27.8)	χ²=0.151	0.697
支气管阻塞	2(2.4)	2(5.6)	χ²=0.095	0.757
支气管镜下表现[例(发生率,%)]
黏膜充血水肿	8(9.8)	4(11.1)	χ²=0.000	1.000
支气管狭窄变形	46(56.1)	24(66.7)	χ²=1.158	0.282
肉芽样新生物	30(36.6)	11(30.6)	χ²=0.401	0.526
干酪样坏死物	30(36.6)	8(22.2)	χ²=2.364	0.124
脓性分泌物	12(14.6)	5(13.9)	χ²=0.011	0.915

表1

图1~3

表2

表3

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组别	0级	1级	2级	3级	4级
观察组(82例)	49(59.75)	17(20.73)	7(8.54)	6(7.32)	3(3.66)
对照组(36例)	8(22.22)	14(38.89)	8(22.22)	5(13.89)	1(2.78)
合计(118例)	57(48.31)	31(26.27)	15(12.71)	11(9.32)	4(3.39)

组别	显效	有效	无效
观察组(82例)	52(63.4)	14(17.1)	16(19.5)
对照组(36例)	10(27.8)	12(33.3)	14(38.9)
合计(118例)	62(52.5)	26(22.0)	30(25.4)