肺癌患者气道支架置入术后咳嗽咯痰的变化及处理

Changes and treatment of cough and expectoration in the patients with lung cancer after airway stent placements

目的评估肺癌患者气道支架置入术后咳嗽咯痰的变化,以及临床相应处理.方法纤维支气管镜直视下在叶支气管以上的气道置入金属支架,比较术前、术后3 d内及术后1～2个月患者咳嗽频繁程度、咯痰困难程度、咯痰量与粘蛋白含量及肺功能的变化.结果术后3 d内患者咳嗽频繁程度显著增加,咯痰困难程度、咯痰量与粘蛋白含量增加不明显,肺功能中VC、FEV1和PEF明显改善;术后1～2个月咳嗽频繁程度接近术前水平,咯痰困难程度、咯痰量与粘蛋白含量明显增加,以覆膜支架更为显著,肺功能持续改善.合理选择支架、镇咳化痰药物及抗生素等措施可以减轻术后3 d内患者咳嗽频繁程度及术后1～2个月咯痰困难程度、咯痰量与粘蛋白含量的增加.结论气道置入金属支架在改善恶性中央气道狭窄患者通气功能的同时对咳嗽咯痰有一些不利影响,采取相应处理能起到一定的作用.

Objective To evaluate the changes and clinic countermeasures of cough and expectoration in the patients with lung cancer after airway stent placements. Methods With the fibrobronchoscope, metal stents were placed in tracheas, main bronchia or right intermediary bronchia. It was compared that the degrees of cough and expectoration difficulties, the volumes and mucin content of sputa and lung functions before the placements, within 3 d and 1 to 2 months after operation. Results Within postoperative 3 days, the patients coughed more frequently, but VC, FEV1 and PEF were improved significantly. In postoperative 1 to 2 months, the degrees of cough were close to preoperative degrees, lung functions kept on improved conditions, but expectoration difficulties, volumes and mucin contents of sputa increased markedly, especially in the patients with tectorial membrane stents. Proper stents and reasonable treatment including use of antitussive, apophlegmatisant and antibiotics could decrease the degrees of cough within postoperative 3 days, and expectoration difficulties, volumes and mucin contents of sputa in postoperative 1 to 2 months. Conclusion To the patients with malignant central airway constriction, metal stent placement would improve ventilative functions but bring difficulties for cough and expectoration. The side complications would be relieved through corresponding treatments.