纤支镜气管内注入异烟肼联合利福平治疗支气管结核临床观察

Local Intratracheal Administration of Isoniazid and Rifampicin via Bronchoscope in the Treatment of Bronchial Tuberculosis

目的 探讨经纤维支气管镜(简称纤支镜)气管内局部注入异烟肼联合利福平治疗支气管结核的临床疗效及其影像学的改善情况。方法 选取医院2015年6月至2018年6月收治的支气管结核患者152例,按双色球法分为对照组和试验组,各76例。两组患者前2个月均予H3R3Z3E3方案[即每周给予异烟肼(H)、利福平(R)、吡嗪酰胺(Z)、乙胺丁醇(E)3次]治疗,后4个月均以H3R3方案治疗;试验组患者加行经纤支镜气管内局部注入异烟肼联合利福平治疗,每周1次,共6周。结果 试验组总有效率为98.68%,显著高于对照组的86.84%(P<0.05);试验组患者治疗结束1,3,6个月后痰菌阴转率分别为67.11%,81.58%,98.68%,显著高于对照组的34.21%,44.74%,71.05%(P<0.05);试验组患者治疗6个月后的病灶吸收率为98.68%,明显高于对照组的71.05%,肺不张发生率为1.32%,显著低于对照组的11.84%(P<0.05);试验组患者治疗后的血清腺苷脱氨酶(ADA)和乳酸脱氢酶(LDH)水平均显著低于对照组(P<0.05),试验组与对照组不良反应发生率相当(18.42%比19.74%,χ^2=0.043,P=0.837>0.05)。结论 经纤支镜气管内局部注入异烟肼联合利福平治疗支气管结核,可明显提高痰菌阴转率、病灶吸收率,降低肺不张发生率和血清中特异性指标水平。

Objective To explore the application of local intratracheal administration of isoniazid and rifampicin through bronchoscope in the treatment of bronchial tuberculosis and its influence on the improvement of imaging.Methods A total of 152 patients with bronchial tuberculosis admitted in the hospital from June 2015 to June 2018 were selected and divided into control group and experimental group by double-color sphere method,76 cases in each group.Both groups were given the H3 R3 Z3 E3 regimen in the first 2 months,i.e.,isoniazid(H),rifampicin(R),pyrazinamide(Z),ethambutol(E)were given 3 times a week;then all patients were treated with H3 R3 for 4 months.The experimental group was added with local intratracheal injection of isoniazid combined with rifampicin,once a week for 6 weeks.Results The total effective rate of the experimental group was 98.68%,which was significantly higher than86.84%of the control group(P<0.05).The sputum negative conversion rates in the fiberoptic bronchoscopy group were 67.11%,81.58%and 98.68%after 1,3 and 6 months of treatment,respectively,which were significantly higher than 34.21%,44.74%and71.05%in the control group(P<0.05).After 6 months of treatment,the absorption rate of lesions in the fiberoptic bronchoscopy group was 98.68%,which was significantly higher than 71.05%in the control group;the incidence of atelectasis was 1.32%,which was significantly lower than 11.84%in the control group(P<0.05).The serum ADA and LDH levels in the experimental group were significantly lower than those in the control group(P<0.05).The incidences of adverse reactions had no significant difference between the two groups(18.42%vs.19.74%,χ^2=0.043 P=0.837>0.05).Conclusion Local intratracheal administration of isoniazid combined with rifampicin via bronchoscope is effective in the treatment of bronchial tuberculosis.It can significantly improve the sputum negative conversion rate,focus absorption rate,reduce the incidence of atelectasis and serum specific index concentration after treatment.