经纤维支气管镜沐舒坦灌洗治疗感染性肺不张

Evaluation on the efficacy and safety of mucosolvin in the treatment of infection-associated atelectasis via bronchoscopy

目的为临床寻找更方便有效的治疗感染性肺不张的方法。方法73例住院患者。男,49例,女24例;年龄18￣89岁,病程3￣15d,经X光胸片或CT证实为肺不张,且经纤支镜除外异物、畸形、肿瘤、结核等,确定为非特异性感染所致,分为常规治疗组、沐舒坦灌洗组。常规治疗组35例在纤支镜下使用生理盐水灌洗和抗感染对症治疗。沐舒坦灌洗组38例,将沐舒坦用5￣10mL生理盐水稀释,在纤维支气管镜下分次灌注到炎性肺不张处,其他治疗同常规治疗组。2组均每天复查胸部X线片,未复张的患者在灌注药物第8天时比较疗效。结果两组在年龄、性别和病程上差异无显著性(均P>0.05)。常规治疗组治愈21例,好转12例,无效2例;沐舒坦治疗组35例治愈32例,好转5例,1例无效。沐舒坦灌洗组的治愈率(84.2%)显著高于常规治疗组(60%)(P<0.05)。沐舒坦灌洗组累计平均手术操作时间为(28.5±9.5)min,明显少于常规治疗组的(42.8±12.2)min(P<0.01);沐舒坦灌洗组的治愈时间为(3.9±1.6)d,显著低于常规治疗组的时间(5.4±1.7)(dP<0.01);两组的治愈好转率([94.3%),(97.4%)]之间没有统计学差异(P>0.05)。结论经纤支镜沐舒坦灌洗能够缩短灌洗操作时间和治愈时间,降低手术风险,更适应于感染性肺不张的治疗。

[Objective] To search and study a more effective and convenient method in the treatment of infection-associated atelectasis, [Method] 73 patients （49 male and 24 female, age ranged from 18 to 89 years and their courses of disease were from 3 to 15d） with infection-associated atelectasis confirmed by X ray or CT were enrolled in the study, The following conditions were excluded by bronchoscopy： airway foreign body, airway anomalies, tumor, tuberculosis. The patients were divided into 2 groups： conventional therapy group and mucosolvin lavaging group. In the conventional therapy group, 35 patients were treated with flexible bronchoscopy and medication whereas in mucosolvin lavaging group（38 patients） mucosolvin （30-60 mg） were infused via bronchoscopy. Chest X ray or CT was regularly reviewed（every day） for every patient, The curative effect of patients that did not recovery was recorded after 8 days. [Results] There was no significant difference in age, sex and course of disease （P 〉0,05）. In conventional therapy group, 21 patients were cured, 12 cases improved and 2 cases without change, In mucosolvin lavaging group, 32 patients were cured, 5 cases improved and 1 cases without change, The two groups had a significant difference in cure ratio （84,2% VS 60%） （P 〈0.05）. The recovering times were significant difference between mucosolvin lavaging group （5.4±1,7） d and conventional therapy group （3.9±1.6） d （P 〈0,01）, The average time of lavaging in mucosolvin group （28.5±9.5） min was much shorter than the conventional therapy group （42.8_±12.2） min （P 〈0.01）, No obvious side effect was observed, [Conclusion] Mucosolvin irrigation via bronchoscopy was an effective and convenient method for treatment of infection-associatd atelectasis,