纤维支气管镜介导治疗耐多药肺结核的临床分析

Clinical efficiency of intervention with bronchofiberosopy on multi-drug resistant pulmonary tuberculosis

目的探讨纤维支气管镜(简称纤支镜)导管介导结核空洞内注药对耐多药肺结核的治疗效果。方法将63例耐多药肺结核病患者分为治疗组和对照组,治疗组采用纤支镜灌注治疗加全身化疗,对照组只进行全身化疗。进行痰涂片检查、胸部X线或者CT检查、肝肾功能检查。结果疗程结束时,治疗组咯血症状明显改善,其痰菌转阴率87.0%、病灶吸收率83.8%、空洞闭合缩小率74.1%,明显高于单纯化疗组的59.3%、56.2%、40.6%,差异具有统计学意义(P<0.05)。治疗组和对照组分别有3例和7例出现一过性肝功能异常,应用保肝降酶药后恢复正常。结论经纤支镜给药配合全身化疗耐多药肺结核疗效显著,优于单纯全身化疗。

Objective To evaluate the clinical efficiency of intervention with bronchofiberoscopy in treatment of mud-drug resistant pulmonary tuberculosis. Methods Sixty-three patients with identified multi- drug resistant pulmonary tuberculosis in our department from 2007 to 2009 were randomly divided into experi- ment group （ n = 31 ） and control group （ n = 32 ）. The experiment group was treated by bronchial lavage with bronchofiberoscopy once per 2 weeks for 9 to 15 times and general anti-tuberculotic treatment, and the control group only received the later treatment. Sputum smear examination, chest X-ray filming/CT scanning, and liver and renal function were carried out. Results At the end of treatment, the symptoms （ such as cough and hae- moptysis） were greatly improved, the sputum negative conversion was 87.0%, the foei absorption was 83.8%, and cavity close was 74.1% in the experiment group, with the later 3 parameters significantly higher than those of control group （59.3% , 56.2% and 40.6% , P 〈0. 05）. There were liver dysfunction in 3 cases of experi- ment group and 7 cases of control group. They all recovered after routine treatment with hepato-protective and transaminase-descending drugs. Conclusion Bronchial lavage with bronchofiberoscopy combined with chemo- therapy exerts significant effect in the treatment of multi-drug resistant pulmonary tuberculosis, superior to chemotherapy alone.