探讨450例次支气管热成形术治疗重度哮喘术后近期严重并发症的处理策略

Investigation of processing strategy of recent serious complications of 450 cases of bronchial thermoplasty in treatment of severe asthma

目的:探讨450例次支气管热成形术(BT)治疗重度哮喘术后近期(3周)严重并发症的处理策略。方法:2016年4月至2018年5月我院150例重度哮喘患者接受BT治疗,共完成450例次手术。整理所有完成手术患者术后3周并发症发生及处理情况。结果:术后3周内150例患者中102例(68%)出现呼吸系统并发症。206例次手术(45.7%)出现呼吸系统并发症共342例次。并发症类型主要为哮喘急性发作(51例次,11.3%)、咳嗽(81例次,18%)、咳痰(115例次,25.6%)、痰中带血(55例次,12.2%)、胸痛(38例次,8.4%)、肺炎(25例次,5.6%)、肺不张(21例次,4.7%)。在术后1周多数并发症可自行缓解或给予药物等相关对症治疗后好转,所有患者未出现呼吸心跳停止及死亡等严重不良事件发生。结论:应用BT术治疗重度哮喘,近期观察显示总体效果良好,部分伪膜形成阻塞气道所致严重肺不张的患者,在气管镜下予以反复灌洗及冷冻处理可取得良好的效果,因此,在患者术后近期应配备床边支气管镜,以便出现严重并发症时能做出紧急处理,提高手术的疗效。

Objective:To probe into the processing strategy of recent(three weeks)serious complications of 450 cases of bronchial thermoplasty(BT)in treatment of severe asthma.Methods:150 cases of patients with severe asthma and who received BT treatment in our hospital,which 450 operations were performed.Then,the occurrence and management of complications after operation for 3 weeks were summarized.Results:Within 3 weeks after surgery,in 150 cases of patients,which 102(68%)had respiratory complications.There were 342 cases of respiratory complications in 206 operations(45.7%).The main types of complications were acute attack of asthma(51 cases,11.3%),cough(81 cases,18%),expectoration(115 cases,25.6%),blood in sputum(55 cases,12.2%),chest pain(38 cases,8.4%),pneumonia(25 cases,5.6%)and atelectasis(21 cases,4.7%).Most of the complications could be relieved by themselves or improved after symptomatic treatment such as medication.And there was no serious adverse events such as cardiac arrest and death occurred in all patients.Conclusions:The application of bronchial thermoplasty in treatment of severe asthma,which the recent observation shows that the effect is good.Some patients with severe atelectasis caused by obstruction of airway caused by pseudomembranes can get good result by repeated lavage and cryotherapy under bronchoscope.Therefore,patients should be equipped with bedside bronchoscopy in the near future,so that serious complications can be dealt with urgently to improve the clinical effect of surgery.