目的 探讨经纤维支气管镜局部灌洗注药治疗结核性支气管扩张的临床疗效.方法 本组43例结核性支气管扩张患者除常规抗感染或规范抗结核治疗外,配合使用纤维支气管镜进行气道内灌洗和注药,观察患者应用纤维支气管镜治疗前、后的临床表现、实验室检查及胸部X线改变.结果 全身用药加局部灌洗注药治疗后,患者体温下降,咳嗽、咳痰及咯血明显减少,外周血白细胞数降低,胸部X线示结核及支气管扩张感染等病灶明显改善.治疗有效率达97.67％.结论 经纤维支气管镜局部灌洗注药能有效清除气道内痰栓、小血块及分泌物,解除支气管阻塞,改善肺功能,较好地控制感染,并使活动性肺结核患者传染性减低,提高痰结核菌检查的阴转率,是一项安全、迅速、疗效确切的治疗结核性支气管扩张的有效措施.%Objective To explore the clinical efficacy of local bronchofiberscopic lavage and medical injections for tuberculous bronchiectasis.Methods 43 patients with tuberculous bronchiectasis received bronchofiberscopic lavage and medical injections in addition to conventional anti-infection treatment and standard antituberculosis therapy.The clinical manifestations,laboratory findings,and chest X-ray features were observed before and after the bronchofiberscopic treatment.Results After administration of general and local medications,body temperature was declined; cough,expectoration,and hemoptysis were markedly decreased; peripheral leukocyte count was lowered; and tuberculous lesions and infection lesions of bronchiectasis were obviously improved on X-ray examinations.The treatment-effective rate is 97.67％.Conclusions Local bronchofiberscopic lavage and medical injections can effectively clear intra-airway sputum bolts,smaller clots,and secretions,resulting in relief of bronchial obstruction,improvement in lung function,reduced infectivity in patients with active pulmonary tuberculosis,and an increased reversion rate of tubercule bacillus in sputum.It is a safe,rapid,effective approach for tuberculous bronchiectasis.
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