摘要目的 探讨电子支气管镜下冷冻治疗联合局部注药治疗支气管结核的疗效.方法 选择2013年1月至2016年12月在咸阳市中心医院呼吸内科及咸阳市中心医院东郊分院(传染病院)经病理确诊的支气管结核210例,分为单纯冷冻治疗组及冷冻联合局部注药治疗组,两组患者均给予全身抗结核化疗;单纯冷冻治疗治疗组在患者服用抗结核药物治疗2周后开始支气管镜下冷冻治疗,联合组在冷冻治疗的基础上给予局部注射异烟肼、利福平治疗.治疗结束后观察两组患者总有效率、气促评分、FEV1、气道狭窄改善情况,以及对比两组患者之间的镜下治疗次数及病程长短.结果 两组患者治疗总有效率均为100％,但联合局部注药治疗组的显效率(83.1％)高于单纯冷冻治疗组(72.8％);两组患者治疗前在气促评分、FEV1、气道内径差异无统计学意义(2.51±0.88,2.63±0.51,P=0.359;1.96±0.82,1.17±0.77,P=0.590;2.45±1.21,3.01±1.15,P=0.542),治疗后两组患者的气促评分、FEV1、气道内镜均明显得到改善,但两组之间差异仍无统计学意义(0.93±0.62,0.81±0.43,P=0.700;3.53±0.77,3.66±0.53,P=0.339;5.84±0.81,6.01±0.49,P=0.616);两组患者在治疗次数上,联合用药组明显少许单纯冷冻治疗组,差异有统计学意义(P=0.012),且联合用药组病程亦短于单纯冷冻治疗组.结论 电子支气管镜冷冻联合局部用药能够提高支气管结核的治疗效果,缩短患者病程,并且是安全、可靠的,值得临床推广.

abstractsObjective To explore the effect of bronchoscopic cryotherapy combined with local injection on airway obstruction caused by bronchial Tuberculosis (BT).Methods 210 patients pathologically diagnosed as BT in Respiration Medicine,Xianyang Central Hospital and Dongjiao Branch,Xianyang Central Hospital (infectious disease hospital) between January 2013 and December 2013 were selected and divided into pure cryotherapy group (PCG) and cryotherapy combined with local injection group (CCLJG).Both groups received systemic anti-tuberculosis chemotherapy.PCG began to receive bronchoscopic cryotherapy 2 weeks after taking anti-Tuberculosis drugs,while CCLJG was administered with local injection of isoniazide and rifampicin,based on cryotherapy.After treatment,the total effective rates,anhelation scores,FEV1,airway stenosis improvements in both groups were observed.The numbers of bronchoscopic treatments and courses of disease between two groups were compared.Results The total effective rates in both groups were 100％.But the marked improvement rate in CCLJG (83.1％) was higher than that in PCG (72.8％).Before treatment,the differences between two groups in anhelation score,FEV1 and airway bronchoscope were not statistically significant (2.51 ± 0.88,2.63 ± 0.51,P =0.359;1.96±0.82,1.17±0.77,P =0.590;2.45±1.21,3.01±1.15,P =0.542).After treatment,the anhelation score,FEV1 and airway bronchoscope in both groups were significantly improved,but still the differences were not statistically significant (0.93 ± 0.62,0.81 ± 0.43,P =0.700;3.53 ± 0.77,3.66 ± 0.53,P =0.339;5.84±0.81,6.01±0.49,P =0.616).The numbers of treatments in CCLJG was obviously lower than those in PCG.Their difference was statistically significant (P =0.012).Besides,the course of disease in CCLJG was shorter than that in PCG.Conclusions Electronic bronchoscopic cryotherapy combined with local injection can improve the curative effect of BT and shorten patients' course of disease.It is safe,reliable and worthy of clinical popularization.