支气管热成形术治疗重度哮喘1例

Bronchial thermoplasty for severe asthma in China: A case report and literature review

目的 报道接受支气管热成形术（bronchial thermoplasty,BT）治疗的重度哮喘患者1例疗效.方法 回顾2014年2月我科收治的1例接受BT治疗的重度哮喘患者临床诊疗过程,患者女性,47岁,支气管哮喘病史＞10年.通过射频消融导管的热能量去除哮喘患者气道增生的平滑肌,减轻气道痉挛和气流受限,减少急性发作频率.BT治疗分3个阶段完成,每个阶段间隔3周：第一阶段治疗右下叶,第二阶段治疗左下叶,第三阶段治疗双肺上叶.结果 3阶段手术均过程顺利,患者耐受良好.每阶段术后患者均诉治疗侧轻微胸痛,未予特殊处理,均于3d后自行缓解.第三阶段治疗后患者出现发热,经抗生素治疗后次日体温恢复正常.术后1个月哮喘控制评分较术前改善9分,FEV1、FVC、PEF、MVV分别较术前改善33.8％（1.98 ～ 2.65 L）、22.3％（2.78 ～ 3.40 L）、60.4％（4.87 ～ 7.81 L/s）和77.2％（63.36～ 112.28 L/min）.结论 BT治疗重度哮喘患者安全有效,耐受性良好.

Objective To report the efficacy of one patients with severe asthma treated by bronchial thermoplasty （BT）. Methods Clinical diagnosis and treatment process of the patient with severe asthma who were treated by BT in our hospital in February 2014 were retrospectively analyzed. BT was performed via 3 bronchoscopy sessions spaced 3 weeks apart. Right lower lobe and left lower lobe were treated separately during the first and the second sessions, both upper lobes were treated during the third session. Then the efficacy and safety of BT were discussed by combining the case and published literatures. Results The operation of the three sessions went smoothly and the patient was well tolerated. Mild pain in treated lateral chest was reported immediately after BT during each session, which was relieved spontaneously without any specific treatment. Fever occurred in the patient on the first day after BT during the third session, and then descended to normal in the next day with antibiotics. Postoperative follow-up showed that the patient was in stable condition, his asthma symptoms and pulmonary function were improved comparing to preoperative data. Conclusion BT shows good efficacy and safety for the patient with severe asthma with well tolerance.