支气管镜灌注术联合抗生素治疗肺癌术后感染的疗效观察

Efficacy of bronchoscopic perfusion combined with antibiotics for post-operative infection in patents with lung cancer

目的探讨支气管镜灌注术(BP)联合抗生素治疗肺癌术后感染的效果及对血清肿瘤坏死因子α(TNF-α)、白细胞介素-8(IL-8)、超敏C反应蛋白(hs-CRP)和降钙素原(PCT)水平的影响。方法选取2017年5月至2018年9月间西安市北方医院收治的80例肺癌术后感染患者,采用随机数表法分为观察组和对照组,每组40例。对照组患者采用常规抗感染治疗,观察组患者在常规治疗基础上应用BP联合局部灌注抗生素治疗,比较两组患者临床疗效、呼吸力学指标、血清TNF-α、IL-8、hs-CRP、PCT及不良反应情况。结果观察组患者临床治疗总有效率为92.5%,高于对照组患者的75.0%,差异有统计学意义(P<0.05)。治疗前,两组患者的气道峰压(PIP)、动态顺应性(Cdyn)、呼吸做功(WOB)和气道阻力(Raw)指标比较,差异无统计学意义(P>0.05)。治疗后,两组患者的PIP、WOB和Raw指标均下降,且观察组均低于对照组,两组患者Cdyn指标均上升,且观察组高于对照组,差异均有统计学意义(均P<0.05)。治疗前,两组患者TNF-α、IL-8、hs-CRP和PCT指标比较,差异无统计学意义(P>0.05)。治疗后,两组患者TNF-α、IL-8、hs-CRP和PCT指标均下降,且观察组上述指标均低于对照组,差异均有统计学意义(均P<0.05)。治疗期间,对照组患者出现呛咳1例,低氧血症1例,发绀1例;观察组患者出现低氧血症1例,对症治疗后,两组患者症状均消失。两组患者不良反应情况比较,差异无统计学意义(P>0.05)。结论采用BP联合抗生素治疗肺癌术后感染患者疗效确切,可有效减轻炎症反应,提升呼吸功能。

Objective To study the efficacy of bronchoscopic perfusion(BP)combined with antibiotics in the treatment of post-operative infection in lung cancer and its effect on serum levels of tumor necrosis factor-alpha(TNF-alpha),interleukin-8(IL-8),hypersensitive C-reactive protein(hs-CRP)and procalcitonin(PCT).Methods Eighty patients with infection after operation for lung cancer were selected as the study subjects at Xi’an Northern Hospital between May 2017 and September 2019.They were randomly divided into an observation group and a control group with 40 patients in each group.The observation group was treated with BP combined with local perfusion of antibiotics based on conventional treatment and the control group was given conventional treatment.The clinical efficacy,respiratory mechanic indexes,serum TNFalpha,IL-8,hs-CRP and PCT and adverse reactions were compared between the two groups.Results After treatment,the overall efficacy rate was 92.5%in the observation group which was significantly higher than75.0%of the control group(P<0.05).Before the treatment,there was no significant difference in the peak inspiratory pressure(PIP),dynamic lung compliance(Cdyn),work of breathing(WOB)and air way resistance(Raw)between the two groups(P>0.05).However,after the treatment,PIP,WOB and Raw decreased in both groups with the observation group lower than the control group(all P<0.05).However,Cdyn increased in both groups with the observation group higher than the control group(all P<0.05).There was no significant difference in the levels of TNF-α,IL-8,hs-CRP and PCT between the two group(P>0.05)before the treatment.However,after the treatment,TNF-α,IL-8,hs-CRP and PCT levels decreased in both groups with the observation group lower than the control group(all P<0.05).During the treatment,cough occurred in 1 patient,hypoxemia occurred in 1 patient and cyanochroia in 1 patient in the control group.In the observation group,hypoxemia occurred in 1 patient.They were cured after symptomatic treatment.There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion BP combined with antibiotics is effective in the treatment of infection after operation for lung cancer,which can effectively alleviate inflammation and improve respiratory function.