高渗葡萄糖、凝血酶胸腔内注射配合补肺弥经汤对Ⅱ～Ⅲ期矽肺合并反复自发性气胸患者免疫功能、肺功能及运动耐量的影响

Effect of intrathoracic injection of hypertonic glucose and thrombin combined with Bufei Mijing decoction on immune function, lung function and exercise tolerance in patients with stage Ⅱ～Ⅲ silicosis complicated with spontaneous recurrent pneumothorax

目的观察高渗葡萄糖、凝血酶胸腔内注射配合补肺弥经汤对Ⅱ期和Ⅲ期矽肺合并反复自发性气胸患者免疫功能、肺功能及运动耐量的影响。方法将62例Ⅱ期和Ⅲ期矽肺合并反复自发性气胸患者随机分为观察组31例和对照组31例,对照组给予高渗葡萄糖、凝血酶胸腔内注射治疗,观察组在对照组基础上给予补肺弥经汤治疗。观察2组治疗前、拔除引流管后次日(治疗后)临床症状积分、免疫功能、血气分析与肺功能、Borg困难指数、6分钟行走试验(6MWT)距离、圣乔治呼吸问卷(SGRQ)评分变化,统计2组留管时间、住院时间及出院后随访3个月时复发率。结果2组治疗后各临床症状积分与总积分均较治疗前显著降低(P均<0.05),观察组均显著低于对照组(P均<0.05);2组治疗后CD3^+、CD4^+、CD4^+/CD8^+比值、p(O2)、Sa(O2)、p(O2)/Fi(O2)和肺活量(VC)、肺总量(TLC)、残气量(RV)、肺一氧化碳弥散量(DLCO)。均较治疗前显著升高(P均<0.05),CD8^+和p(CO2)均较治疗前显著降低(P均<0.05),观察组治疗后以上指标改善情况均显著优于对照组(P均<0.05)。2组治疗后Borg困难指数、SGRQ评分均较治疗前显著降低(P均<0.05),且观察组均显著低于对照组(P均<0.05);2组6MWT均较治疗前显著增加(P均<0.05),且观察组显著长于对照组(P<0.05)。观察组留管时间、住院时间均显著短于对照组(P均<0.05),出院后随访3个月时复发率显著低于对照组(P<0.05)。结论高渗葡萄糖、凝血酶胸腔内注射配合补肺弥经汤治疗Ⅱ期和Ⅲ期矽肺合并反复自发性气胸不仅可明显提高患者免疫功能、肺功能、运动耐量和生活质量,还可显著缩短留管时间与住院时间,降低复发率,值得临床推荐。

Objective It is to observe the effects of intrathoracic injection of hypertonic glucose and thrombin combined with Bufei Mijing decoction on immune function,lung function and exercise tolerance in patients with stageⅡ~Ⅲsilicosis complicated with spontaneous recurrent pneumothorax.Methods Sixty-two patients with stage Ⅱ and Ⅲ silicosis complicated with spontaneous recurrent pneumothorax were randomly divided into observation group(31 cases)and control group(31 cases).The control group was treated with hyperosmolar glucose and thrombin by intrathoracic injection.On the basis of the control group,the observation group was treated with Bufei Mijing decoction.The changes of the clinical symptoms scores,immune function,blood gas analysis and lung function,Borg difficulty index,6-minute walking test(6MWT)distance,St.George’s Respiratory Questionnaire(SGRQ)scores before treatment and after removal of the drainage tube were observed in the two groups,retention time,hospitalization time and recurrence rate after 3 months of follow-up after discharge were recorded.Results After treatment,the scores of symptoms and total scores of the two groups were significantly lower than those before treatment(P<0.05),and the scores in the observation group were significantly lower than the control group(P<0.05).After treatment,CD3^+,CD4^+,CD4^+/CD8^+,pa(O2),Sa(O2),pa(O2)/Fi(O 2)and VC,TLC,RV and DLCO were significantly higher than those before treatment(P<0.05),and CD8^+ and paC(O2)were significantly lower than those before treatment in the two groups(P<0.05).The improvements of the above indicators after treatment in the observation group were significantly better than the control group(P<0.05).After treatment,the Borg difficulty index and SGRQ score were significantly lower than those before treatment in the two groups(P<0.05),and the indexes in the observation group were significantly lower than the control group(P<0.05).The 6MWT of the 2 groups were significantly increased compared with the pre-treatment(P<0.05),and the observation group was significantly longer than the control group(P<0.05).The tube-retained time and hospitalization time in the observation group were significantly shorter than those in the control group(P<0.05),while the recurrence rate was significantly lower than that of the control group after 3 months of follow-up after discharge(P<0.05).Conclusion Hypertonic glucose and thrombin by intrathoracic injection combined with Bufei Mijing decoction can not only improve the immune function,lung function,exercise tolerance and quality of life,but also significantly shorten the tube-retained time and hospitalization time,reduce the recurrence rate in the treatment of stageⅡandⅢsilicosis with recurrent spontaneous pneumothorax,it is worthy of clinical recommendation.