Department of Respiratory Medicine, Xi Jing Hospital, Fourth Military Medical University, Xi'an, China.
Respir Care. 2013 Aug;58(8):1351-9. doi: 10.4187/respcare.02218. Epub 2013 Jan 23.
To describe the self-expanding endobronchial occluder, as utilized in bronchoscopic lung volume reduction, with a 36 month follow-up procedure.
Twenty-three subjects with severe emphysema were recruited and underwent flexible bronchoscopic placement of self-expanding endobronchial occluders. Outcomes were assessed at 1 week, 1-month, 3-, 6-, 12-, 24-, and 36-month intervals. Feasibility, safety, and efficacy were analyzed by means of pulmonary function testing, 6-min walk test, dyspnea score, BODE (body mass index, air-flow obstruction, dyspnea, and exercise capacity) index, and St George's Respiratory Questionnaire.
Fifty-eight self-expanding endobronchial occluders were implanted into 23 lobes previously selected. No displacement was found during the follow-up. Five subjects experienced postoperative complications of cough, and 6 subjects had lobar pneumonia, which were not located in any of the blocked segments. The FEV1 in 18 subjects was improved by > 15%, compared with baselines (P < .001), and the mean first efficacy time and maximal efficacy time were 5.65 ± 1.51 months and 6.35 ± 3.08 months, respectively. No significant changes were observed in FVC or the ratio of residual volume to TLC. The 6-min walk distance, dyspnea score, and St George's Respiratory Questionnaire total score were improved in 22 subjects over a 24-month period, and a minority of subjects continued to improve through to the end of the study. Mean baseline BODE index had improved during follow-up, but not at the study's conclusion.
This preliminary study demonstrates early significant improvements in pulmonary function, 6-min walk distance, dyspnea score, BODE index, and quality of life after placement of the self-expanding endobronchial occluder in bronchoscopic lung volume reduction. Its placement also proved both easy and safe. However, the initial improvements were maintained long-term for only a minority of subjects.
描述自膨式支气管内封堵器，用于支气管镜下肺减容术，并进行 36 个月的随访。
招募了 23 例严重肺气肿患者，行软性支气管镜下自膨式支气管内封堵器置入术。在 1 周、1 个月、3、6、12、24 和 36 个月时评估结局。通过肺功能测试、6 分钟步行试验、呼吸困难评分、BODE（体重指数、气流阻塞、呼吸困难和运动能力）指数和圣乔治呼吸问卷评估可行性、安全性和疗效。
58 个自膨式支气管内封堵器被植入 23 个先前选择的肺叶。在随访期间未发现移位。5 例患者术后出现咳嗽并发症，6 例患者发生大叶性肺炎，但均不在任何被封堵的节段。与基线相比，18 例患者的 FEV1 改善>15%（P<.001），平均首次疗效时间和最大疗效时间分别为 5.65±1.51 个月和 6.35±3.08 个月。FVC 或残气量与 TLC 比值无明显变化。22 例患者在 24 个月期间 6 分钟步行距离、呼吸困难评分和圣乔治呼吸问卷总分均得到改善，少数患者在研究结束时仍在继续改善。平均基线 BODE 指数在随访期间有所改善，但在研究结束时并未改善。
这项初步研究表明，在支气管镜下肺减容术中放置自膨式支气管内封堵器后，早期可显著改善肺功能、6 分钟步行距离、呼吸困难评分、BODE 指数和生活质量。其放置既简单又安全。然而，最初的改善仅在少数患者中长期维持。
