静脉用抗菌素对良性气管狭窄呼吸内镜介入治疗术后长期疗效的影响

目的 探讨良性气管狭窄患者呼吸内镜介入治疗后静脉用抗菌素治疗1个月对长期疗效的影响.方法 回顾性分析从2012年5月至2015年4月因不同病因致良性气管狭窄收住广西医科大学第一附属医院呼吸内科的75例患者的临床资料.按术后接受静脉用抗菌素治疗的时间分组,其中抗菌素治疗时间≤2周为抗菌素短期治疗组(即短期组),抗菌素治疗时间≥1个月为抗菌素持续治疗组(即持续组),同时所有患者住院期间及出院后均雾化吸入阿米卡星和布地奈德悬液治疗共计6个月.近期及6个月后分析2组患者的治疗效果和并发症.结果 经呼吸内镜介入治疗后,短期组狭窄段气管内径由(3.81±0.80) mm增加到(12.55±1.25) mm(t=-46.41,P＜0.05),持续组狭窄段气管内径由(3.78±0.66) mm增加到(12.35±1.43) mm (t =-50.60,P＜0.05),差异均有统计学意义;短期组气促评分由3.41±0.78降低到0.55±0.63(t=19.53,P＜0.05),持续组气促评分由3.43±0.66降低到0.54±0.51 (t =3.43,P＜0.05),差异均有统计学意义.术后近期治疗效果均为100.00％,持续组6个月的总体有效率显著高于短期组(93.48％ vs 44.83％,x2=22.26,P＜0.05).2组均未出现二重感染等抗菌素治疗的并发症.结论 良性气管狭窄者介入术后较长时间应用抗菌素可明显减少再狭窄率,提高长期疗效.

Management of post bronchoscopic interventional therapy for patients with benign tracheal stenosis:effect of long-term intravenous antibiotics use

Objective To evaluate the efficacy of long-term intravenous antibiotics in the treatment of patients with benign tracheal stenosis after bronchoscopic interventional therapy.Methods Seventy-five patients with benign tracheal stenosis were divided into short-term group and long-term group according to the duration of intravenous antibiotics after bronchoscopic interventional therapy.Patients in short-term group were treated with intravenous antibiotics for less than two weeks.Patients in long-term group were treated with intravenous antibiotics for more than one month.And they also treated with inhalation of amikacin and budesonide suspension for six months during hospitalization and after discharge.The treatment efficacy and complications were evaluated after six months.Results In short-term group,the tracheal diameter increased from (3.81 ±0.80) mm to (12.55t1.25) mm (t =-46.41,P＜0.05),the dyspnea index decreased from 3.41±0.78 to 0.55±0.63 (t =19.53,P ＜0.05).In long-term group,the tracheal diameter increased from (3.78±0.66) mm to (12.35±1.43) mm (t =-50.60,P ＜0.05),the dyspnea index decreased from 3.43±0.66 to 0.54 ± 0.51 (t =3.43,P ＜ 0.05).The immediate efficacy all reached 100.00％ in both two groups.In six months,the overall effective rate in long-term group was higher than that in short-term group (93.48％ vs 44.83％,x2 =22.26,P ＜0.05).There was no complications happened in both two groups.Conclusions Long-term intravenous antibiotic therapy in patients with benign tracheal stenosis after bronchoscopic interventional therapy can reduce the restenosis rate significantly and improve the long-term efficacy.