硬质气管镜+可弯曲支气管镜对恶性中央型气道狭窄患者呼吸力学和短期预后的影响

目的　探究硬质气管镜+可弯曲支气管镜对恶性中央型气道狭窄患者呼吸力学及短期预后的影响。方法　选择2017年9月至2021年9月临沂市中心医院收治的恶性中央型气道狭窄患者80例，按1∶1比例分为常规组和联合组，各40例。常规组男28例，女12例，年龄（57.65±9.10）岁；联合组男30例，女10例，年龄（58.07±9.34）岁。常规组使用喉镜+可弯曲支气管镜进行介入治疗，联合组使用硬质气管镜+可弯曲支气管镜进行介入治疗。术后，比较两组患者的临床疗效、气促指数、卡式（KPS）评分、气道狭窄程度、肺活量（VC）、第1秒用力呼气容积（FEV1）、最大呼气流量（PEF）、氧分压（PaO₂）、二氧化碳分压（PaCO₂）、动脉血氧饱和度（SaO₂）及并发症发生率。统计学方法采用t检验、χ²检验、Fisher确切概率法。结果　联合组和常规组患者的临床总有效率比较差异无统计学意义［97.50%（39/40）比92.50%（37/40），χ²=1.053，P=0.305］；术后，联合组的气促指数、气道狭窄程度均低于常规组，KPS评分高于常规组，两组比较差异均有统计学意义（均P<0.05）；术后，两组患者PEF水平比较差异无统计学意义（P>0.05），联合组患者VC、FEV1水平均高于常规组（均P<0.05）；手术前后，两组患者的PaO₂、PaCO₂、SaO₂水平比较差异均无统计学意义（均P>0.05）；联合组患者的总并发症发生率虽低于常规组［5%（5/40）比30%（12/40）］，但差异无统计学意义（χ²=3.660，P=0.056）。结论　硬质气管镜+可弯曲支气管镜对恶性中央型气道狭窄患者进行介入治疗，可有效改善其气道狭窄程度，恢复气道功能通畅，缓解其气促表现，并且相较喉镜有着更低的并发症发生率，保证了患者短期预后良好。

Effects of rigid bronchoscopy combined with flexible bronchoscopy onrespiratory mechanics and short-term prognosis in patients with malignantcentral airway stenosis

Objective　To explore the effects of rigid bronchoscopy combined with flexiblebronchoscopy on respiratory mechanics and short-term prognosis in patients withmalignant central airway stenosis. Methods　A total of 80patients with malignant central airway stenosis who were treated in LinyiCentral Hospital were selected between September 2017 and September 2021, andthey were divided into a conventional group and a combined group according tothe ratio of 1:1, with 40 cases in each group. There were 28 males and 12females in the conventional group, with an age of (57.65±9.10) years old; therewere 30 males and 10 females in the combined group, with an age of (58.07±9.34)years old. The conventional group was treated with laryngoscopy and flexiblebronchoscopy for interventional therapy, while the combined group was treatedwith rigid bronchoscopy and flexible bronchoscopy. After surgery, the clinicalefficacy, shortness of breath index, Karnofsky Performance Status (KPS) score,degree of airway stenosis, vital capacity (VC), forced expiratory volume in 1second (FEV1), peak expiratory flow (PEF), partial pressure of oxygen (PaO₂),partial pressure of carbon dioxide (PaCO₂), arterial oxygensaturation (SaO₂), and incidence of complications were comparedbetween the two groups. t test, χ² test, and Fisher exacttest were used for statistical analysis. Results　There was nostatistically significant difference in the total clinical effective ratebetween the combined group and the conventional group [97.50% (39/40) vs.92.50% (37/40), χ²=1.053, P=0.305]. After surgery, the shortnessof breath index and airway stenosis degree in the combined group were lowerthan those in the conventional group, and the KPS score was higher than that inthe conventional group, with statistically significant differences between thetwo groups (all P<0.05). Aftersurgery, there was no statistically significant difference in the PEF levelbetween the two groups (P>0.05),and the levels of VC and FEV1 in the combined group were higher than those inthe conventional group (both P<0.05).There were no statistically significant differences in the PaO₂,PaCO₂, and SaO₂ levels between the two groups before andafter surgery (all P>0.05). Theincidence of total complications in the combined group was lower than that inthe conventional group [5% (5/40) vs. 30% (12/40)], but the difference was notstatistically significant (χ²=3.660, P=0.056). Conclusions　Interventional therapy with rigid bronchoscopy and flexible bronchoscopyfor patients with malignant central airway stenosis can effectively improve thedegree of airway stenosis, restore the patency of airway function, and relievethe shortness of breath. Compared with the laryngoscopy, it has fewercomplications and ensures better short-term prognosis.