血凝酶联合支气管肺泡灌洗对支气管扩张合并咯血患者肺功能、气道炎症及预后的影响

Effects of hemagglutinin combined with bronchoalveolar lavage on pulmonary function, airway inflammation and prognosis in patients with bronchiectasis complicated with hemoptysis

目的探讨血凝酶联合支气管肺泡灌洗对支气管扩张合并咯血患者肺功能、气道炎症及预后的影响。方法前瞻性选取2017年6月至2018年12月94例于南方医科大学深圳医院重症医学科治疗的支气管扩张合并咯血患者为研究对象,采用随机数表法将其分为观察组和对照组各47例。观察组患者采用血凝酶联合支气管肺泡灌洗治疗,对照组患者给予血凝酶治疗,7 d为一个疗程,均治疗1个疗程。比较两组患者治疗后的肺功能第一秒用力呼气容积(FEV1)、用力肺活量(FVC)及一秒用力呼气量占用力肺活量比值(FEV1/FVC)水平、症状体征消失时间、气道炎症及并发症发生情况。结果治疗后,两组患者的FEV1、FVC及FEV1/FVC水平均明显升高,观察组患者的FEV1、FVC及FEV1/FVC水平分别为(2.20±0.45) L、(2.91±0.42) L、(67.50±6.83)%,明显高于对照组的(1.69±0.33) L、(2.48±0.37) L、(56.08±5.57)%,差异均有统计学意义(P<0.05);治疗后观察组和对照组患者咯血[(3.27±1.07) d vs (5.09±1.42) d]、咳嗽咳痰[(7.23±2.14) d vs (10.85±3.12) d]、发热[(4.72±1.45) d vs (6.93±1.86) d]及湿啰音[(10.28±2.69) d vs (13.27±3.21) d]消失时间比较,观察组明显短于对照,差异有统计学意义(P<0.05);治疗后,两组患者的白细胞介素-6 (IL-6)、白细胞介素-17(IL-17)水平较治疗前明显下降,白细胞介素-10 (IL-10)水平较治疗前明显上升,且观察组患者的IL-6、IL-17水平明显低于对照组,IL-10水平明显高于对照组,差异均有统计学意义(P<0.05);观察组患者的胸闷心悸、头痛、胃肠道不适、血压下降的总并发症的发生率为4.26%,明显低于对照组的17.02%,差异有统计学意义(P<0.05)。结论血凝酶联合支气管肺泡灌洗治疗支气管扩张合并咯血能有效改善患者肺功能和相关症状体征,缓解气道炎症,减少并发症发生,具有临床推广应用价值。

Objective To investigate the effects of hemagglutinin combined with bronchoalveolar lavage on pulmonary function, airway inflammation, and prognosis in patients with bronchiectasis complicated with hemoptysis.Methods A total of 94 patients with bronchiectasis and hemoptysis, who admitted to Department of Critical Care Medicine, Shenzhen Hospital of Southern Medical University from June 2017 to December 2018, were prospectively selected and divided into the observation group and control group according to random number table method, with 47 patients in each group. The patients in the observation group were treated with hemagglutinase combined with bronchoalveolar lavage, and patients in the control group were treated with hemagglutinase. All patients were treated for one course. The first second forced expiratory volume(FEV1), forced vital capacity(FVC), and the ratio of forced expiratory volume to forced vital capacity(FEV1/FVC) in one second, the disappearance time of symptoms and signs, airway inflammation and complications were compared between the two groups. Results After treatment, FEV, FVC and FEV1/FVC in the observation group were(2.20±0.45) L,(2.91±0.42) L,(67.50±6.83)%, respectively, which were significantly higher than corresponding(1.69±0.33) L,(2.48±0.37) L,(56.08±5.57)% in the control group(all P<0.05);the disappearance time of hemoptysis, cough and expectoration, fever, moist rales in the observation group were(3.27 ± 1.07) d,(7.23 ± 2.14) d,(4.72 ± 1.45) d,(10.28 ± 2.69) d, respectively, significantly shorter than corresponding(5.09 ± 1.42) d,(10.85 ± 3.12) d,(6.93±1.86) d,(13.27±3.21) d of the control group(all P<0.05);the levels of IL-6, IL-17 and IL-10 in the two groups were significantly lower than those before treatment, the levels of IL-6 and IL-17 in the observation group were significantly lower than those in the control group, and the level of IL-10 in the observation group was significantly higher than that in the control group;the differences were significant(all P<0.05);the incidence of total complications of chest distress, palpitation, headache, gastrointestinal discomfort, and blood pressure drop in the observation group was 4.26%,which was significantly lower than 17.02% in the control group(P<0.05). Conclusion Hemagglutinin combined with bronchoalveolar lavage can effectively improve pulmonary function and related symptoms and signs, alleviate airway inflammation and reduce complications in patients with bronchiectasis and hemoptysis, which has clinical application value.