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目的观察支扩方结合支气管灌洗治疗支气管扩张合并感染的远期疗效。方法将73例支气管扩张急性加重期患者随机分为:中药+灌洗组(n=23)、灌洗组(n=24)、中药组(n=25)。中药+灌洗组急性期给予中药支扩感染方加减,结合支气管灌洗及抗生素等西医常规治疗,稳定期予支扩稳定方加减;灌洗组不服用中药,其余治疗同中药+灌洗组;中药组不做灌洗,其余治疗同中药+灌洗组。观察1年或2年内急性发作次数以及圣乔治呼吸问卷评分、肺功能FVC%或FEV1%等指标,评价各组的远期临床疗效,并用logistic回归分析评价1年及2年临床疗效的影响因素。结果中药+灌洗组1年期临床好转率为82.6%,灌洗组为45.5%,中药组为45.8%,中药+灌洗组高于灌洗组、中药组(P<0.05)。多因素分析结果表明,中药治疗有助于提高1年、2年期临床疗效(P<0.05),支气管镜局部灌洗有助提高1年期临床疗效(P<0.05),但对2年期疗效无明显影响(P>0.05)。多肺叶受累可降低1年、2年期临床疗效(P<0.05),合并肺心病降低2年期临床疗效(P<0.05)。结论中药治疗与支气管镜局部灌洗都是提高支气管扩张症的远期疗效的独立因素,支扩方结合支气管灌洗治疗支气管扩张合并感染,能明显提高远期疗效,减少急性发作次数,改善患者生活质量,且安全性良好。
Objective To observe the long-term curative effect of bronchiectasis combined with bronchiectasis by bronchiectasis. Methods A total of 73 patients with acute exacerbation of bronchiectasis were randomly divided into two groups: Chinese herbal medicine + lavage group (n = 23), lavage group (n = 24) and traditional Chinese medicine group (n = 25). Traditional Chinese medicine + lavage group given the traditional Chinese medicine during the acute bronchoscopy spread side addition and subtraction, combined with bronchial lavage and antibiotics and other conventional Western medicine, stable period to support extended stability side addition and subtraction; lavage group does not take traditional Chinese medicine, the remaining treatment with traditional Chinese medicine + irrigation Wash group; Chinese medicine group did not do lavage, the rest of the treatment with traditional Chinese medicine + lavage group. The number of acute episodes within 1 year or 2 years and the scores of Saint George’s Respiratory Questionnaire, FVC% of lung function or FEV1% were observed to evaluate the long-term clinical efficacy of each group. Logistic regression analysis was used to evaluate the factors of 1-year and 2-year clinical efficacy . Results The one-year clinical improvement rate was 82.6% in traditional Chinese medicine plus lavage group, 45.5% in lavage group and 45.8% in traditional Chinese medicine group. The Chinese medicine + lavage group was higher than that in lavage group and traditional Chinese medicine group (P <0.05). The results of multivariate analysis showed that Chinese medicine treatment could improve the clinical efficacy at 1 year and 2 years (P <0.05), and the local lavage by bronchoscopy could improve the 1-year clinical efficacy (P <0.05) No significant effect (P> 0.05). Multi-lobe involvement reduced 1-year and 2-year clinical efficacy (P <0.05), and combined pulmonary heart disease reduced 2-year clinical efficacy (P <0.05). Conclusion Traditional Chinese medicine and bronchoscopy local lavage are independent factors to improve the long-term efficacy of bronchiectasis, bronchiectasis combined with bronchial lavage combined treatment of bronchiectasis, can significantly improve long-term efficacy, reduce the number of acute attacks, improve patients Quality of life, and good safety.