河北医科大学学报 ›› 2022, Vol. 43 ›› Issue (3): 290-294.doi: 10.3969/j.issn.1007-3205.2022.03.09

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支气管动脉栓塞术治疗肺结核大咯血患者对肺功能、动脉血气的影响及术后复发相关因素分析

  

  1. 1.陕西省汉中三二〇一医院介入科,陕西 汉中 723000；2.陕西省汉中市中心医院心内科,陕西 汉中 723000； 3.陕西省西电集团医院放射科,陕西 西安 710077

  • 出版日期:2022-03-25 发布日期:2022-04-14
  • 作者简介:李强（1979-），男，陕西汉中人，陕西省汉中三二〇一医院副主任医师，医学学士，从事介入诊治研究。
  • 基金资助:

    陕西省医学科学研究项目（2002D55）

The impact of bronchial artery embolization on pulmonary function and arterial blood gas in patients with massive hemoptysis due to pulmonary tuberculosis and related factors of postoperative recurrence

  1. 1.Department of Interventional Therapy, No. 3201 Hospital of Hanzhong City, Shaanxi Province,

    Hanzhong 723000, China; 2.Department of Cardiovascular Medicine, Central Hospital of

    Hanzhong City, Shaanxi Province, Hanzhong 723000, China; 3.Department of Radiology, Xidian Group Hospital, Shaanxi Province, Xi′an 710077, China

  • Online:2022-03-25 Published:2022-04-14

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摘要：

目的 探讨支气管动脉栓塞术（bronchial artery embolization，BAE）与常规内科治疗对肺结核大咯血患者肺功能、动脉血气的影响及BAE后复发相关因素分析。

方法 回顾性分析经常规内科治疗无效的肺结核大咯血患者78例，均给予BAE治疗，观察所有患者肺功能及动脉血气指标恢复情况，观察所有患者术后大咯血复发情况并分析其相关危险因素。

结果 78例患者治愈16例，显效30例，有效20例，无效12例，总有效率为86.62%。所有患者常规内科治疗后用力肺活量(forced vital capacity,FVC)、用力呼气量(forced expiratory volume,FEV)、FEV/FVC、血氧分压(partial pressure of oxygen，PaO2)高于治疗前，动脉血二氧化碳分压(partial pressure of carbon dioxide in artery,PaCO2)低于治疗前；BAE治疗后FVC、FEV、FEV/FVC、PaO2高于治疗前和常规内科治疗后，PaCO2低于治疗前和常规内科治疗后，差异有统计学意义（P＜0.05）。78例患者复发26例(33.33%)。复发组依从性差、剧烈咳嗽、空洞型肺结核、感染、术后不良活动、术后紧张焦虑情绪、GS栓塞材料、支气管扩张概率高于未复发组，差异有统计学意义（P＜0.05）。多因素Logistic回归分析结果显示，治疗依从性、术后不良活动、栓塞材料是肺结核大咯血术后复发的危险因素（P＜0.05）。

结论 BAE能够提高肺结核大咯血临床疗效，加快肺功能恢复，减少咯血，治疗依从性差、术后不良活动、栓塞材料是肺结核大咯血术后复发的危险因素，应提高重视。

关键词: 结核, 肺, 咯血, 支气管动脉栓塞术, 复发

Abstract:

Objective To explore the effects of bronchial artery embolization(BAE) and conventional medical treatment on pulmonary function and arterial blood gas in patients with massive hemoptysis due to pulmonary tuberculosis, and to analyze related factors for recurrence after BAE.

Methods We retrospectively analyzed 78 patients with massive hemoptysis due to pulmonary tuberculosis who had failed conventional medical treatment. All patients were given BAE. The recovery of lung function and arterial blood gas indicators as well as the recurrence of massive hemoptysis and related risk factors were observed in all patients.

Results Among the 78 patients, 16 were cured, and the treatment was markedly effective in 30 patients, effective in 20 patients, and ineffective in 12 patients, with a total effective rate of 86.62%. The FVC, FEV, FEV/FVC and PaO2 of patients after conventional medical treatment were higher than those before treatment, while PaCO2 was lower than that before treatment; the FVC, FEV, FEV/FVC and PaO2 after BAE treatment were significantly higher than those before treatment and after conventional treatment, while PaCO2 was lower than that before treatment and after conventional treatment, with significant difference(P＜0.05). Of 78 patients, 26(33.33%) patients had a postoperative recurrence rate. Recurrence group had a higher rate of poor compliance, intense cough, cavitary tuberculosis, infection, poor postoperative activity, postoperative tension anxiety, GS embolization material and bronchiectasis than non-recurrence group(P＜0.05). Logistic regression showed that good treatment compliance, poor postoperative activity, and embolization material were risk factors for recurrence after massibve hemoptysis due to pulmonary tuberculosis(P＜0.05).

Conclusion BAE can improve the clinical efficacy in the treatment of massive hemoptysis due to pulmonary tuberculosis, accelerate the recovery of pulmonary function, and reduce hemoptysis. Poor treatment compliance, poor postoperative activities, embolization materials are risk factors for the recurrence of massive hemoptysis due to pulmonary tuberculosis after surgery, which should warrant attention.


Key words: tuberculosis, pulmonary, hemoptysis, bronchial artery embolization, recurrence

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