经纤维支气管镜局部灌洗加灌注抗结核药物治疗耐药难治性肺结核的临床研究

Clinical study on the treatment of multi-drug resistant refractoriness pulmonary tuberculosis with bronchofiberscope and catheter intervention after lavaged local environment

目的:探讨纤维支气管镜(FB)局部灌洗加灌注抗结核药物在耐多药难治性肺结核治疗中的价值。方法:将74例耐多药难治性肺结核病人随机分为治疗组和对照组,均常规按复治方案抗结核治疗,治疗组38例经FB局部生理盐水灌洗,清理病灶和疏通气道,纤维支气管镜局部灌注异烟肼0.3g+链霉素0.5g(或丁胺卡那霉素0.4g)。观察两组细菌学阴转、病灶和空洞吸收情况。结果:治疗组细菌学阴转率100%,显著高于对照组55.6%(χ2=11.35,P<0.01),阴转所需时间明显缩短。治疗组病灶显效率(治愈+显著吸收)92.1%,空洞闭合率33.3%,均显著高于对照组38.9%及14.3%(χ2=16.45及5.16,P<0.01及0.05),两组差异具有统计学意义。结论:FB局部灌洗加灌注抗结核药物,可加速细菌学阴转,加快病灶愈合,加快空洞闭合和缩小,缩短疗程,对耐多药难治性肺结核治疗具有实用价值。

Objective： To explore the value of the treatment on multi-drug resistant refractoriness pulmonary tuberculosis with filling antituberculosis drugs with bronchofiberscope and catheter after lavaged local environment. Method： 74 patients with multi-drug resistant refractoriness pulmonary tuberculosis cases were randomly divided into treatment group （38cases） and control group （36 cases）. Two groups were treated by routine retreatment regimen antituberculosis chemotherapy. The treatment group was treated by perfusion with isoniazide （0. 3g） and streptomycin （0. 5g） （or amikacin 0.4g） with bronchofiberscope after repeatedly lavaged local environment by normal saline, and cleaned focus of infection and deoppilation airway. Results. The sputum conversion rate in the treatment group was higher than the control group （100 % vs 55.6 %, χ^2= 11.35, P〈0.01） and sputum conversion time was shorter than the control group. Radiographic improvement rate 92. 1%, and cavity closing rate 33.3% in the treatment group, all of which were higher than the control group （38. 9%, 14.3%.χ^2 =16.45, 5.16, P〈0. 01,0.05）. Conclusion： The efficacy of perfusion anti- tuberculosis drugs after lavaged local environment with broncbofibroscope is better than the routine retreatment regimen in the treatment of multi-drug resistant refractoriness pulmonary tuberculosis. The treatment can quicken sputum conversion and radiographic improvement. The treatment course was shorted. No complication and obvious adverse reaction were observed.