呼吸道瘘患者封堵器治疗前后胸部影像学及病原学情况比较

Comparison of chest imaging and etiology fistula before and after treatment in patients with respiratory tract fistula: With occluder

目的了解呼吸道瘘患者封堵器置入前后肺部感染变化情况。方法本研究为回顾性、观察性研究。选取2016年1月至2022年1月于广东省人民医院诊断为呼吸道瘘并行封堵器治疗的住院患者14例,收集患者人口学资料、原发疾病、合并疾病、呼吸道瘘口部位、封堵器类型、置入前后胸部影像学情况、病原体检测结果、感染指标变化的情况,比较呼吸道瘘患者封堵器置入前后对影像学及感染病原体的影响。结果14例患者中气管食管瘘3例(21.4%),支气管胸膜瘘11例(78.6%)(右侧9例,左侧2例)。共置入封堵器14枚,其中室间隔封堵器3例(21.4%),动脉导管封堵器1例(7.1%),房间隔封堵器10例(71.4%)。置入前肺部感染13例(92.86%),气胸9例(64.29%),胸腔积液10例(71.43%);置入后肺部感染好转率46.15%(6/13),气胸好转率100%(9/9),胸腔积液好转率100%(10/10)。置入前痰培养检出细菌3株、真菌1株,支气管肺泡灌洗液检出细菌3株、真菌1株,胸腔积液检出细菌2株、真菌2株;置入后痰培养检出细菌3株,胸腔积液检出细菌7株,置入封堵器前后细菌感染均以革兰氏阴性菌为主。封堵器置入后的白细胞计数、降钙素原、C反应蛋白水平均较置入前改善(均P<0.05)。结论呼吸道瘘患者普遍合并下呼吸道感染,封堵器置入治疗呼吸道瘘有利于控制肺部感染,气胸吸收,胸腔积液减少,且炎症指标好转。封堵器置入前后均需要重点关注细菌感染,尤其是革兰氏阴性菌感染。

Objective To understand changes in pulmonary infections in patients with respiratory tract fistula before and after the placement of occluder.Methods The study was retrospective and observational.Totally 14 inpatients diagnosed to suffer from respiratory tract fistula and treated with occluder in Guangdong Provincial People′s Hospital from January 2016 to January 2022.The demographic data,primary diseases,concurrent diseases,respiratory tract fistula site,occluder type,chest imaging before and after implantation,pathogen detection results,and changes in infection indicators of patients were collected.The effects of occluder on imaging and infectious pathogens in patients with respiratory tract fistula before and after placement were compared.Results In the 14 patients,3(21.4%)patients with tracheoesophageal fistula,11(78.6%)patients with bronchopleural fistula(9 cases on the right side and 2 cases on the left side)were noted.A total of 14 occluders were implanted,including 3 ventricular septal occluders(21.4%),1 arterial catheter occluder(7.1%),and 10 atrial septal occluders(71.4%).The 13 cases(92.86%)of preoperative pulmonary infection,9 cases(64.29%)of pneumothorax and 10 cases(71.43%)of pleural effusion were noted.The postoperative pulmonary infection improvement with a rate of 46.15%(6/13),pneumothorax improvement with a rate of 100%(9/9),the pleural effusion absorption with a rate of 100%(10/10)were found.The preoperative sputum culture detected 3 strains of bacteria and 1 strain of fungi,the bronchoalveolar lavage fluid detected 3 strains of bacteria and 1 strain of true bacteria,the pleural effusion detected 2 strains of bacteria and 2 strains of fungi,the sputum culture detected 3 strains of bacteria after implantation,and the pleural effusion detected 7 strains of bacteria,Gram-negative bacteria were the main bacterial infections before and after the implantation of occluders.The white blood cell count,procalcitonin and C-reactive protein level after occluder placement were improved compared with those before occluder placement(all P<0.05).Conclusions Patients with respiratory tract fistula are commonly combined with lower respiratory tract infection.The placement of occluder in the treatment of respiratory tract fistula contributes to the controlled lung infection,pneumothorax absorption,reduced pleural effusion and improved inflammation index.Bacterial infection,especially Gram-negative bacterial infection are required to be noted before and after occlude placement.