Mahmood Kamran, Wahidi Momen M, Thomas Samantha, Argento Angela Christine, Ninan Neil A, Smathers Emily C, Shofer Scott L
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, N.C., USA.
Respiration. 2015;89(5):404-13. doi: 10.1159/000381103. Epub 2015 Apr 23.
Central airway obstruction (CAO) occurs in patients with primary or metastatic lung malignancy and nonmalignant pulmonary disorders and results in significant adverse effects on respiratory function and quality of life.
The objective of this study was to assess the effect of therapeutic bronchoscopic interventions on spirometry, dyspnea, quality of life, and survival in patients with CAO.
We prospectively studied patients who underwent therapeutic rigid bronchoscopy for CAO. Spirometry, San Diego Shortness of Breath questionnaire (SOBQ), and SF-36 questionnaire responses were obtained before the procedure and at follow-up 6-8 weeks after the procedure.
Fifty-three patients (24 malignant and 29 nonmalignant CAO), who underwent successful rigid bronchoscopic intervention, were enrolled. Airway stent placement and various debulking techniques including mechanical debridement and heat therapy were used. After bronchoscopy, there was a significant increase in forced vital capacity (2.2 ± 0.91 l before, 2.7 ± 0.80 l after, p = 0.009) and forced expiratory volume at 1 s (1.4 ± 0.60 l before, 1.8 ± 0.67 l after, p = 0.002). The SOBQ score improved from 55.8 ± 30.1 before the procedure to 37.9 ± 27.25 after the procedure (p = 0.002). In the SF-36, there was an improvement in almost all domains, with statistically significant improvement seen in several domains. Benefits were seen independent of the etiology of CAO, site of intervention or stent placement. The patients with malignant CAO, in whom airway patency could not be achieved, had a poor survival.
Alleviation of CAO with therapeutic rigid bronchoscopy results in improvement in spirometry, shortness of breath, quality of life, and survival.
中央气道阻塞（CAO）发生于原发性或转移性肺恶性肿瘤及非恶性肺部疾病患者中，对呼吸功能和生活质量产生重大不良影响。
本研究的目的是评估治疗性支气管镜干预对CAO患者肺活量测定、呼吸困难、生活质量和生存率的影响。
我们对接受治疗性硬质支气管镜检查的CAO患者进行了前瞻性研究。在手术前及术后6 - 8周随访时获取肺活量测定、圣地亚哥呼吸急促问卷（SOBQ）和SF - 36问卷的回复。
纳入了53例成功接受硬质支气管镜干预的患者（24例恶性CAO和29例非恶性CAO）。采用了气道支架置入及各种减瘤技术，包括机械清创和热疗。支气管镜检查后，用力肺活量显著增加（术前2.2±0.91升，术后2.7±0.80升，p = 0.009），第1秒用力呼气量也显著增加（术前1.4±0.60升，术后1.8±0.67升，p = 0.002）。SOBQ评分从术前的55.8±30.1改善至术后的37.9±27.25（p = 0.002）。在SF - 36中，几乎所有领域都有改善，几个领域有统计学意义的显著改善。这些益处与CAO的病因、干预部位或支架置入无关。气道通畅无法实现的恶性CAO患者生存率较差。
治疗性硬质支气管镜减轻CAO可改善肺活量测定、呼吸急促、生活质量和生存率。
