作者：吴静，刘建伟，马建欣，熊胜春，井洪家

单位：

067000 河北省承德市中心医院心胸外科；通信作者：熊胜春，E-mail：wysxr_991@126.com

Units：

Department of Cardiothoracic Surgery，the Central Hospital of Chengde，Chengde 067000，China；Corresponding author：XIONG Shengchun，E-mail：wysxr_991@126.com

关键词：

肺肿瘤；支气管肺泡灌洗；肺叶切除术；淋巴结清扫术；炎性因子

Keywords：

Lung neoplasms；Bronchoalveolar lavage；Lobectomy；Lymph node dissection；Inflammatorycytokines

CLC：

R 734.2

DOI：

DOI：10.3969/j.issn.1008-5971.2020.01.y09

Funds：

2017年承德市科学技术研究与发展计划项目（201707A004）

摘要：

目的　分析经纤维支气管镜支气管肺泡灌洗术治疗老年肺癌患者的临床效果。方法　选取 2016—2017 年承德市中心医院心胸外科收治的老年肺癌患者 96 例，根据治疗方法分为对照组和观察组，各 48 例。对照组患者采用肺叶切除术 + 纵隔淋巴结清扫术治疗，观察组患者在对照组基础上对患侧肺进行经纤维支气管镜支气管肺泡灌洗术治疗。比较两组患者术后临床症状改善时间（包括体温及白细胞计数恢复正常时间、咳痰消失时间、拔管时间、特级护理改二级护理时间）、术后脱离呼吸机 24 h 动脉血气分析指标〔包括 pH 值、动脉血氧分压（PaO 2 ）、动脉血二氧化碳分压（PaCO 2 ）〕、术前及术后 3 d 血清炎性因子〔包括 C 反应蛋白（CRP）、肿瘤坏死因子 α（TNF-α）、白介素 8（IL-8）、降钙素原（PCT）〕水平，并观察两组患者术后并发症发生情况。结果　（1）观察组患者体温及白细胞计数恢复正常时间、咳痰消失时间、拔管时间及特级护理改二级护理时间短于对照组（P<0.05）。（2）观察组患者术后脱离呼吸机 24 h pH 值、PaO 2 高于对照组，PaCO 2 低于对照组（P<0.05）。（3）两组患者术前血清 CRP、TNF-α、IL-8、PCT 水平比较，差异无统计学意义（P>0.05）；观察组患者术后 3 d 血清 CRP、TNF-α、IL-8、PCT水平低于对照组（P<0.05）。（4）两组患者术后并发症发生率比较，差异无统计学意义（P>0.05）。结论　经纤维支气管镜支气管肺泡灌洗术可有效缩短老年肺癌患者术后临床症状改善时间，改善术后动脉血气分析指标，减轻术后炎性反应，且安全性较高。

Abstract：

Objective　To analyze the clinical effect of bronchoalveolar lavage via fiberoptic bronchoscopy in treatingelderly patients with lung cancer. Methods　From 2016 to 2017，a total of 96 elderly patients with lung cancer were selectedin the Department of Cardiothoracic Surgery，the Central Hospital of Chengde，and they were divided into control group andobservation group according to therapeutic methods，with 48 cases in each group. Patients in control group underwent pulmonarylobectomy combined with mediastinal lymph node dissection，while patients in observation group underwent bronchoalveolarlavage via fiberoptic bronchoscopy based on that of control group. Postoperative remission time of clinical symptoms（includingrecovery time of body temperature and WBC，disappearance time of phlegm，time to extubation，transition time from criticalcare to secondary care），arterial blood-gas analysis indicators（including pH value，PaO 2 and PaCO 2 ）24 hours off theventilator after operation，serum levels of inflammatory cytokines（including CRP，TNF-α，IL-8 and PCT）before operationand 3 days after operation were compared between the two groups，and incidence of postoperative complications was observed.Results　（1）Recovery time of body temperature and WBC，disappearance time of phlegm，time to extubation and transitiontime from critical care to secondary care in observation group were statistically significantly shorter than those in control group（P<0.05）.（2）24 h off the ventilator after operation，pH value and PaO 2 in observation group were statistically significantlyhigher than those in control group，while PaCO 2 in observation group was statistically significantly lower than that in controlgroup（P<0.05）.（3）There was no statistically significant difference in serum level of CRP，TNF-α，IL-8 or PCTbetween the two groups before operation（P>0.05），while serum levels of CRP，TNF-α，IL-8 and PCT in observationgroup were statistically significantly lower than those in control group 3 days after operation（P<0.05）.（4）No statisticallysignificant difference of incidence of postoperative complications was found between the two groups（P>0.05）.ConclusionBronchoalveolar lavage via fiberoptic bronchoscopy can effectively shorten the postoperative remission time of clinical symptomsand improve the postoperative arterial blood-gas analysis indicators in treating elderly patients with lung cancer，as well asrelieve the postoperative inflammatory reaction，with relatively high safety.

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