183例次支气管热成形术后近期呼吸不良事件分析

Analysis of short-term respiratory adverse events in 183 bronchial thermoplasty procedures

目的 分析支气管热成形术（BT）治疗重症支气管哮喘术后近期（术后3周）呼吸不良事件发生情况.方法 2014年3月至2016年7月中日友好医院62例重症哮喘患者接受BT治疗,共完成183例次手术.收集术后3周内所有患者呼吸不良事件发生情况,分析可能影响术后不良事件发生的因素.结果 术后3周内62例患者中43例（69.4%）出现呼吸不良事件,87例次手术（47.5%）发生不良事件共153例次.主要不良事件为咳嗽（15例次,8.20%）、咳痰量增加（37例次,20.22%）、呼气峰值流量（PEF）短暂下降（37例次,20.22%）、胸闷（12例次,6.56%）、痰中带血丝（11例次,6.01%）、哮喘急性发作（10例次,5.46%）、肺炎（6例次,3.28%）.多数不良事件在术后1周可自行缓解或经对症治疗消失.无气管插管、恶性心律失常及死亡等严重不良事件发生.患者基础诱导痰嗜酸粒细胞百分比、基础血嗜酸粒细胞百分比、手术次数及术前FEV1占预计值%会影响术后不良事件的发生.术前FEV1占预计值%≥60%可减少术后不良事件发生.结论 应用支气管热成形术治疗重症哮喘近期安全性良好.

Objective To analyze the short-term （ 3 weeks ） adverse respiratory events after bronchial thermoplasty （ BT） in patients with severe asthma.Methods The China-Japan Friendship Hospital recruited 62 patients with severe asthma for BT treatment from March 2014 to July 2016,with a total of 183 BT procedures.The data of adverse respiratory events within 3 weeks after procedure were collected to analyze the factors that might potentially influence the occurrence of adverse events .Results Forty-three patients （69.4%） experienced adverse respiratory events within 3 weeks after treatment.Totally 153 adverse respiratory events occurred after 87 procedures （ 47.5%） .The main adverse events were cough （15 events, 8.20%）, sputum production （37 events, 20.22%）, temporary PEF reduction （37 events, 20.22%）, chest distress （ 12 events, 6.56%）, blood in sputum （ 11 events, 6.01%）, asthma exacerbation （10 events, 5.46%）, and pneumonia （6 events, 3.28%） .Most events were relieved or resolved with standard therapy in 1 week.No severe adverse events including tracheal intubation , malignant arrhythmias or death occurred within 3 weeks after procedure.The baseline eosinophil percentage in induced sputum and blood, operation times, and preoperative FEV1（%predicted） might influence the occurrence of adverse events after treatment .Patients with preoperative FEV 1 （% predicted ） ≥60% had lower risk of adverse events.Conclusion BT showed a good security profile in treating patients with severe asthma within 3 weeks after procedure .