不同年代中国支气管镜应用中严重并发症分析

Analysis of severe complications in application of bronchoscope at different ages in China

目的 探讨中国支气管镜应用中严重并发症的年代差异及原因.方法 依据11项严重并发症标准,通过中国知网搜索2005年12月以前所发表的所有支气管镜应用中发生严重并发症的文献,采取x2检验方法,把相关文献报道的病例分为3组：1985年以前（组一）、1986-1995年（组二）和1996-2005年（组三）,计算其P值予以比较.结果 纳入符合入组条件的文献共10篇,其中组一3篇,组二3篇,组三4篇,结果显示,严重并发症发生率组一为0.497％（267/53 742）,组二为0.291％（243/83 458）,组三为0.942％（248/26 333）.不同年代支气管镜应用的严重并发症中除了死亡率（x^2=2.867,P=0.238）和气胸（x^2=1.926,P=0.382）外,其余9项并发症和每组的总并发症（x^2=181.344,P=0.000）之间的差异均有统计学意义,而且除了组一中的喉气管、支气管痉挛并发症和组二中的结核并发症在三组中最高外,其余并发症均显示组三明显增高.结论 20世纪末到21世纪初,气管、支气管腔内新技术的广泛应用可能是导致组三严重并发症显著增加的主要原因,同时也表明规范介入性内镜操作技术十分必要.例如,欧洲特别是德国十分强调,对危及生命的气道狭窄的治疗首选硬质气管镜,值得探讨.

Objective To investigate the age differences and its reasons of severe complications in the application of bronchoscope in China.Methods According to the 11 criteria of severe complications defined by Jin Faguang,all the papers about severe complications in the application of bronchoscope published before December 2005 were searched through CNKI.The reported cases were divided into group 1 （before 1985）,group 2 （between 1986 and 1995）,and group 3 （between 1996 and 2005）.The chi-square test was used to calculate the P value and compare.Results Ten papers were eligible for the criteria,including three papers in group 1,three papers in group 2,and four papers in group 3.Results showed that the incidence rate of severe complications was 0.497% （267/53 742） in group 1,0.291 % （243/83 458） in group 2,0.941% （248/26 333） in group 3.Except mortality rate （x^2 =2.867,P =0.238） and pneumothorax rate （x^2=1.926,P =0.382）,the incidence rates of severe complications in the application of bronchoscope were of significant difference among different ages in other nine complications and overall complication （x^2=181.344,P =0.000）.Except that the incidence rate of complication of larynx,trachea,bronchus spasm in group 1 and tuberculosis in group 2 were the highest among the three groups,incidence rates of other complications in group 3 were the highest.Conclusions From the late last century to the beginning of this century,the extensive application of new intracavity technology in trachea and bronchus may be the main reason that causes the remarkable increase of severe complications in group 3.This also shows the importance of standardizing the intervene endoscope operation.For example,in Europe especially German,rigid bronchoscopy is layed stress on in the treatment of air way stricture threatening life,which remains to discuss.