摘要目的 探讨支气管热成形术治疗重度支气管哮喘(哮喘)的安全性及有效性.方法 前瞻性观察2014年2-7月广州医科大学附属第一医院6例经长期吸入大剂量糖皮质激素和长效β2-受体激动剂后仍控制不佳的重度哮喘患者,经支气管热成形术治疗后,观察患者术后6个月、术后1年的哮喘症状、急性发作次数、肺通气功能、药物使用变化及术后并发症等.结果 术后6个月,患者哮喘生活质量问卷(miniAQLQ)评分(6.4±0.5)、急性发作频率[0.4(0.1～1.3)次/月]及无症状天数[(21.2±7.2)天/月]较术前明显改善[分别为5.2±0.9、2.0(0.9 ～4.0)次/月、(14.5±3.7)天/月),均P＜0.05];术后6个月患者呼气峰流速(PEF)变异率[(5.6±3.3)％]、吸入糖皮质激素剂量[(800±620) μg/d]及口服糖皮质激素剂量[9.7(1.3 ～ 10.0)mg/d]较术前亦有明显改善[分别为(21.1±7.8)％、(1 133±432)μg/d和15.0(10.0 ～ 20.0) mg/d,均P＜0.05].术后12个月,上述各指标较术前仍有明显改善.手术前后ACQ-6评分、ACT评分、PEF、FVC占预计值％、FEV1占预计值％等差异无统计学意义(均P ＞0.05).治疗期间最常见并发症为咳嗽咳痰(24.1％)和喘息(13.8％),其次为下呼吸道感染及肺不张.1例患者第3次术后12 h出现气胸和呼吸衰竭,经积极处理后缓解.结论 应用支气管热成形术治疗重度哮喘,初步观察显示疗效较好,但有一定并发症,值得进一步观察.

abstractsObjective To assess the effectiveness and safety of bronchial thermoplasty (BT) in the treatment of severe asthma.Methods The safety and effectiveness of BT were studied prospectively in 6 patients with poorly controlled severe asthma on long-term inhaled high-dose glucocorticoids and long-acting beta2-agonists in the First Affiliated Hospital of Guangzhou Medical University.Outcomes assessed after BT included asthma symptoms,frequency of acute exacerbations,pulmonary function,medication adjustment,and postoperative complications at 6 and 12 months after treatment.Results The mini-AQLQ scores (6.4 ± 0.5),the frequency of acute exacerbations [0.4 (0.1-1.3) times/month],and the symptom-free days [(21.2 ± 7.2)days/month] were significantly improved at 6 months after operation compared to those before operation[5.2 ±0.9,2.0(0.9-4.0) times/month,(14.5 ± 3.7) days/month,respectively,P ＜ 0.05].Data collected at the 6th month indicated significant improvements in the variation rate of PEF,the dose of inhaled glucocorticoids and oral glucocorticoids [(5.6 ± 3.3) ％ vs.(21.1 ± 7.8) ％),(800 ± 620) vs.(1 133 ±432) μg/d),9.7(1.3-10.0) vs.15.0(10-20) mg/d,P ＜0.05].Outcomes mentioned above were improved as well at the 12th month.But the ACQ-6 scores,ACT scores,the ratio of PEF and its predicted value(％),the ratio of FVC and its predicted value (％),the ratio of FEV1 and its predicted value(％)were not changed significantly (P ＞ 0.05).The PEF values and lung function measurements remained stable throughout the study period.The most common complications were cough (24.1％),wheezing(13.8％),followed by lower respiratory infection and atelectasis during the treatment.Pneumothorax and respiratory failure occurred in 1 patient 12 h after the third procedure.Conclusion Our preliminary study demonstrated promising effect of BT in the treatment of severe asthma,although there are some complications which need further observation.