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目的探讨支气管镜介导的肺段内隔绝激发试验的安全性及高渗盐激发的支气管收缩反应,同时收集肺泡灌洗液作相关细胞因子测定。方法选择对象为缓解期慢性气道疾病患者(哮喘或慢性阻塞性肺病),分为气道高反应组、COPD组及对照组(肺部病变为右肺中叶以外,无慢性咳喘及COPD者),其中气道高反应组26例,COPD组23例,对照组21例。所有受试者行静息肺功能检查及肺段内高渗盐激发试验,观察激发后肺段内压力变化、激发试验中、试验后的安全性。结果高渗激发后气道高反应组的压力升高最明显(6.20±0.60)cmHO,COPD组次之(3.38±0.34)cmHO,对照组较弱(1.32±0.34)cmHO,气道高反应组与222COPD组、对照组比较,差异都具有显著性(P<0.001);该组肺段内隔绝激发试验,患者耐受良好,仅气道高反应组中有3例哮喘患者诱发支气管哮喘发生,术后经支气管解痉、平喘及气雾剂等治疗缓解,无重症哮喘出现,有5例出现少量痰血,术后3d内基本消失,行肺段内隔绝激发试验者均能耐受,无心律紊乱、呼吸衰竭等不良事件发生。结论支气管镜介导的肺段内隔绝激发试验对气道高反应性研究在技术方法、激发试验、激发剂释放等方面有较好的安全性,为开展气道内激发研究建立了新方法。
OBJECTIVE: To investigate the safety of endoscopic bronchoscopic-mediated isolated exclusion test of lung segments and the bronchoconstriction induced by hypertonic saline. Meanwhile, bronchoalveolar lavage fluid was collected for cytokine determination. Methods Patients with chronic airway disease (asthma or chronic obstructive pulmonary disease) were enrolled in this study. They were divided into two groups: high airway response group, COPD group and control group (pulmonary lesion was outside middle of right lung, no chronic cough and COPD ), Including 26 cases of airway hyperresponsiveness group, 23 cases of COPD group and 21 cases of control group. All subjects underwent resting pulmonary function tests and intranasal hypertonic saline challenge test to observe the changes in pressure within the pulmonary passages after challenge and the safety of the challenge test and the test. Results After hyperosmotic challenge, the airway hyperresponsiveness group had the most significant increase in pressure (6.20 ± 0.60) cmHO, the COPD group (3.38 ± 0.34) cmHO, and the control group (1.32 ± 0.34) cmHO. The airway hyperresponsiveness group Compared with 222COPD group and control group, the difference was significant (P <0.001). In this group of isolated exclusion test, the patients were well tolerated. Only three patients with asthma in bronchial hyperresponsiveness group had bronchial asthma, Postoperative bronchial spasm, asthma and aerosol therapy to ease, no severe asthma, there are 5 cases of a small amount of sputum blood, basically disappeared after 3d, the line of exclusion within the excitation test were tolerant, No heart rhythm disorders, respiratory failure and other adverse events. Conclusions Bronchoscopic-mediated intra-isolated exclusion test of lung segments has good safety in airway hyperresponsiveness in terms of technical methods, excitation test, and release of stimulants, and has established a new method for the study of airway excitability.