电子纤维支气管镜下局部注入激素对支气管结核的疗效观察

Observation on locally injecting glucocorticoid for bronchial tuberculosis via electronic fibreoptic bronchoscopy

目的观察经电子纤维支气管镜下局部注入激素治疗支气管结核的临床疗效。方法选择确诊为支气管结核患者66例,在常规抗结核治疗的基础上按治疗方案的不同分为观察组(左氧氟沙星+阿米卡星+地塞米松)与对照组(左氧氟沙星+阿米卡星),对两组患者行纤维支气管镜下注射给药,观察两组在治疗后纤维支气管镜冲洗液涂片抗酸杆菌转阴率及镜下改变情况。结果治疗2个月后,观察组在纤维支气管镜下的改善情况与对照组相比较,观察组总有效率为76.5%,而对照组为46.9%,组间差异有统计学意义(P<0.01);痰检结果观察组转阴率为79.4%,对照组转阴率为62.5%,两者间差异无统计学意义(P>0.05)。结论化疗加纤维支气管镜直视下注入左氧氟沙星、阿米卡星、地塞米松能提高临床疗效,但是加用激素对痰菌转阴率无影响。

Objective To observe the clinical curative effect on bronchial tuberculosis by locally injecting glucocorticoid via electronic fibreoptic bronchoscopy.Methods The selection enrolled 66 cases of patients confirmed with bronchial tubercut,and the patients were divided into two groups（observation group and control group） for different treatment plans based on conventional therapy for tuberculosis.The treatment group was applied with lavo-ofloxacin,amikacin and glucocorticoid,while the control group with lavo-ofloxacin and amikacin.After injecting the drugs respectively for two groups of patients,observation was made on the negative conversion ratio of acid-fast bacillus which was searched on flush fluid smear sampled by fibreoptic bronchoscopy to two groups in post-treatment,and the change in bronchoscopy was observed.Results After two months′ treatment,the improvement in fibreoptic bronchoscopy between two groups had statistical significance（P〈0.05）.The total effective rate was 76.5% and 46.9% respectively in observation group and control group.The negative conversion ratio of acid-fast bacillus on flush fluid smear in observation group was 79.4%,while that of control group was 62.5%,which was of no statistical significance（P〈0.05）.Conclusion Conventional therapy on tuberculosis plus injecting lavo-ofloxacin,amikacin and glucocorticoid via fibreoptic bronchoscopy in direct vision could raise clinical curative effect,but combining with glucocorticoid is not effective on negative conversion ratio of acid-fast bacillus on flush fluid smear.