【摘要】 目的探究支气管镜介入冷冻治疗和高频电治疗对老年肉芽增生型支气管结核伴发呼吸困难患者的预后和炎症因子指标的影响。方法选取2017年1月10日至2017年11月2日于我院接受治疗的经细菌学或病理检查确诊的60例老年肉芽增生型支气管结核伴发呼吸困难患者作为研究对象,呼吸困难的干预方法是清除支气管结核肉芽增生的病灶。本研究采用随机数字表法将研究对象分为化疗组（采用2HRZE/10HR化疗方案）和联合组（采用2HRZE/10HR化疗方案联合支气管镜介入冷冻治疗和高频电疗）,各30例。比较两组患者的治疗效果、治疗前、后肺功能、肺泡灌洗液（BALF）中炎症因子水平及并发症发生情况。结果联合组的治疗总有效率为86.67%,显著高于化疗组的63.33%,差异具有统计学意义（P<0.05）。治疗前,两组的FVC占预计值的百分比、FEV₁占预计值的百分比、PEF占预计值的百分比及MMEF75/25占预计值的百分比比较,差异不具有统计学意义（P>0.05）;治疗后,两组的FVC占预计值的百分比、FEV₁占预计值的百分比、PEF占预计值的百分比及MMEF75/25占预计值的百分比均显著升高,且联合组高于化疗组,差异具有统计学意义（P<0.05）。治疗前,两组的BALF中IL-1、IL-6、TNF-α、CRP水平比较,差异不具有统计学意义（P>0.05）;治疗后,两组的BALF中IL-1、IL-6、TNF-α、CRP水平均显著降低,且联合组低于化疗组,差异具有统计学意义（P<0.05）。联合组患者并发症总发生率为26.67%,与化疗组的13.33%比较,差异不具有统计学意义（P>0.05）。结论支气管镜介入冷冻治疗和高频电治疗应用于老年肉芽增生型支气管结核伴发呼吸困难患者的疗效较好,能够协同2HRZE/10HR化疗方案发挥作用,抗炎作用明显。更多还原

【Abstract】 Objective To investigate the effects of bronchoscopic interventional cryotherapy and high-frequency electrotherapy on the prognosis and inflammatory factors of elderly patients with granulomatous bronchial tuberculosis complicated with dyspnea. Methods From January 10, 2017 to November 2, 2017, 60 elderly patients with granulomatous bronchial tuberculosis complicated with dyspnea diagnosed by bacteriological or pathological examination and received treatment in our hospital were selected as the study objects. The intervention method of dyspnea was to remove the focus of granulomatous of bronchial tuberculosis. In this study, the study objects were divided into chemotherapy group（given 2 HRZE/10 HR chemotherapy regimens） and combination group（given 2 HRZE/10 HR chemotherapy regimens combined with bronchoscopic interventional cryotherapy and high-frequency electrotherapy）, with 30 cases in each group. The therapeutic effect, lung function, the levels of inflammatory factors in bronchoalveolar lavage fluid（BALF） before and after treatment and complications were compared between the two groups. Results The total effective rate of treatment in the combination group was 86.67%,which was significantly higher than 63.33% in the chemotherapy group, the difference was statistically significant（P<0.05）.Before treatment, there were no significant differences in the ratio of FVC in predictive value, ratio of FEV₁ in predictive value, ratio of PEF in predictive value and ratio of MMEF75/25 in predictive value between the two groups（P>0.05）; after treatment, the ratio of FVC in predictive value, ratio of FEV₁ in predictive value, ratio of PEF in predictive value and ratio of MMEF75/25 in predictive value of the two groups increased significantly, and those in the combination group were higher than the chemotherapy group, the differences were statistically significant（P <0.05）. Before treatment, there were no significant differences in the levels of IL-1, IL-6, TNF-α and CRP in BALF between the two groups（P >0.05）; after treatment, the levels of IL-1, IL-6, TNF-α and CRP in BALF in the two groups reduced significantly, and those in the combination group were lower than the chemotherapy group, the differences were statistically significant（P<0.05）. The total incidence of complications in the combined group was 26.67%, which was not statistically significant compared with 13.33%in the chemotherapy group（P >0.05）. Conclusion Bronchoscopic interventional cryotherapy and high-frequency electrotherapy are effective in the elderly patients with granulomatous bronchial tuberculosis complicated with dyspnea,which can cooperate with 2 HRZE/10 HR chemotherapy and with obvious anti-inflammatory effect.更多还原