Mizumori Yasuyuki, Mochiduki Yoshiro, Nakahara Yasuharu, Kawamura Tetsuji, Sasaki Shin, Morimoto Akie, Tsukamoto Hiroaki
Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Japan.
J Thorac Dis. 2015 Mar;7(3):413-21. doi: 10.3978/j.issn.2072-1439.2015.01.10.
Existing medical treatments have limitations in the management of very severe chronic obstructive pulmonary disease (COPD).
We performed bronchoscopic lung volume reduction (BLVR) using transbronchial infusion of autologous blood and thrombin (BLVR with blood) in three patients with very severe COPD whose dyspnea could not be relieved by maximum medical management. Two patients underwent BLVR with blood in the left and right lungs at intervals of a half-year or a year, and one patient underwent this procedure in only the right lung. We assessed the changes in pulmonary function, exercise capacity and quality of life before and after BLVR with blood in a total of five procedures.
The subjects were 58- to 74-year-old males. Their forced expiratory volume in one second (FEV1) percent predicted ranged from 14.8% to 23.4%. BLVR with blood achieved significant improvements as follows (values before → after the procedure, mean ± standard deviation): FEV1 0.45r the L → 0.76r the L (P=0.004), inspiratory capacity 1.50cityo L → 2.05±.05c L (P=0.015), 3-minute walk test 46.8nuteo m → 89.6±34.5 m (P=0.004). Lung function peaked several months after BLVR with blood and returned to nearly the baseline level in 6 months, but exercise capacity was better than that at baseline for at least 12 months. St. George's Respiratory Questionnaire (SGRQ), measured in two patients before and 12 months after the procedure, showed remarkable improvements (-15.6 and -11.9 units).
BLVR with blood is an effective palliative treatment for very severe COPD.
现有医学治疗方法在极重度慢性阻塞性肺疾病（COPD）的管理方面存在局限性。
我们对3例极重度COPD患者进行了经支气管注入自体血和凝血酶的支气管镜肺减容术（用血进行支气管镜肺减容术），这些患者的呼吸困难通过最大程度的药物治疗无法缓解。2例患者分别于半年或一年的间隔期在左肺和右肺进行了用血支气管镜肺减容术，1例患者仅在右肺进行了该手术。我们在总共5次手术中评估了用血支气管镜肺减容术前后的肺功能、运动能力和生活质量变化。
受试者为58至74岁男性。他们的一秒用力呼气容积（FEV1）预计值范围为14.8%至23.4%。用血支气管镜肺减容术取得了显著改善，如下所示（手术前→手术后的值，均值±标准差）：FEV1从0.45L升至0.76L（P = 0.004），吸气量从1.50L升至2.05±0.05L（P = 0.015），3分钟步行试验从46.8米升至89.6±34.5米（P = 0.004）。肺功能在用血支气管镜肺减容术后数月达到峰值，并在6个月内恢复至接近基线水平，但运动能力至少在12个月内优于基线水平。在2例患者手术前和术后12个月测量的圣乔治呼吸问卷（SGRQ）显示有显著改善（分别为-15.6和-11.9个单位）。
用血支气管镜肺减容术是治疗极重度COPD的一种有效姑息治疗方法。
