经支气管镜大容量灌洗治疗支气管扩张症并感染患者的前瞻性研究

Selective Large Volume Broncholavage for Acute Exacerbation of Bronchiectasis by Bronchonscopy

目的评价经支气管镜大容量灌洗治疗支气管扩张症并感染的安全性和有效性。方法采用随机、对照的临床试验设计,对2009年8月至2014年1月收治的支气管扩张症并感染患者进行研究。入选病例在合理内科药物治疗前提下,65例患者随机分为大容量灌洗组（A组,n=21）、小容量灌洗组（B组,n=22）及对照组（C组,n=22）。灌洗组均接受一次治疗,大容量灌洗组灌洗量为500~2 000 m L,小容量灌洗组灌洗量为100~200 m L。观察记录患者的一般情况,记录并比较治疗前、后各组简化的临床肺部感染评分（CPIS）、C反应蛋白（CRP）水平、抗生素使用时间、住院时间及治疗有效率。结果 A组灌洗量为（1 250.0±403.3）m L,B组灌洗量为（141.0±41.2）m L。A组的住院时间和抗生素使用时间分别为（8.4±1.0）d和（7.9±1.1）d,短于B组[（13.5±1.6）d、（11.6±2.4）d]和对照组[（15.3±3.2）d、（13.3±2.6）d]（P〈0.05）;总有效率为95.23%,高于B组（81.82%）和C组（68.19%）;第7 d A组的CPIS评分为（1.9±1.4）分,低于B组[（2.7±0.8）分]和C组[（3.7±0.9）分]（P〈0.05）;A组CRP下降更为显著,差异均有统计学意义（P〈0.05）。A组和B组不良反应分别为一过性低氧血症（23.81%、9.09%）、窦性心动过速（100%、68.18%）、气道黏膜损伤（38.09%、13.64%）、血压升高（19.05%、13.64%）。结论经支气管镜选择性大容量支气管灌洗治疗支气管扩张并感染安全、有效,值得临床推广。

Objective To evaluate the efficacy and safety of selective large volume broncholavage by bronchonscopy in treatment of patients with acute exacerbation of bronchiectasis. Methods A singlecenter randomized control,non-blind clinical trial was conducted. A total of 65 patients were randomly divided into Group A（ large volume broncholavage group,n = 21）,Group B（ mini- large volume broncholavage group,n = 22） and Group C（ control group,n = 22）. All patients received routine therapy of acute exacerbation of bronchiectasis while additional broncholavage was administered in the treatment groups for only once. Warm normal saline solution was instilled for Group A at volume of 500 to 2 000 m L and for Group B at volume of 100 to 200 m L. The baseline characteristics,Simplified Clinical Pulmonary Infection Score（ CPIS） and C-reactive protein（ CRP） were recorded at the first and on 7thday. The duration of antibiotic use,the length of hospital stay and total effective rate were compared among three groups. Results The lavage volume was（ 1 250. 0 ± 403. 3） m L for Group A and（ 141. 0 ± 41. 2） m L for Group B. The length of hospital stay and duration of antibiotic use were（ 8. 4 ± 1. 0） d and（ 7. 9 ± 1. 1） d respectively,shorter than those in Group B [（ 13. 5 ± 1. 6） d,（ 11. 6 ± 2. 4） d] and Group C [（ 15. 3 ± 3. 2） d,（ 13. 3 ± 2. 6） d]with significant difference between three groups（ all P 〈 0. 05）. The total effective rates was 95. 23% in Group A,higher than those in Group B（ 81. 82%） and Group C（ 68. 19%）（ all P 〈 0. 05）. The CPIS on the 7thday of Group A was 1. 9 ± 1. 4,lower than that in Group B（ 2. 7 ± 0. 8） and Group C（ 3. 7 ± 0. 9）（ P〈 0. 05）. The CRP of Group A decreased more quickly than Group B and Group C. The adverse events occurred in Group A and Group B including transient hypoxemia（ 23. 81%,9. 09%, respectively）,tarchycardia（ 100%,68. 18%,respectively）,airway mucosal injury（ 38. 09%,13. 64%,respectively） and elevated blood pressure（ 19. 05%,13. 64%, respectively）. Conclusion Selective large volume broncholavage through bronchonscopy is an effective and safe treatment for patients with acute exacerbation or bronchiectasis.