Abstract
Goal of the study: to investigate the changes in ventilation and gas exchange function of the lungs before and after 1-1.5 months after installation of endobronchial valve (EV) aimed at cavity healing in pulmonary destructive tuberculosis patients. Materials and methods. 74 HIV negative patients in the age from 18 to 61 years old suffering from destructive pulmonary tuberculosis were examined. The changes in the pulmonary ventilation capacity (VC, FEV1 , FEV1 /VC%, PEF, MEF25,75) and blood gases (РаО2 , РаСО2, SaО2 %) before and in 4-6 weeks after EV installation have been studied. Results. After 1-1.5 months after EV installation no significant changes in the pulmonary ventilation function were found in 62.2% of patients, 43.2% of patients demonstrated no significant changes in gas exchange function and there were certain changes in the remaining patients. Reduction of pulmonary ventilation capacity due to large bronchi obstruction, restrictive changes and pulmonary gas exchange were manifested through reduction of FEV1 in 18.9% (95% CI 11.6-29.3%) of patients, PEF – in 20.3% (95% CI 12.7-30.8%), VC – in 22.9% (95% CI 14.9%-33.8%) and PaO2 – in 32.4% (95% CI 22.9-43.7%) of patients. Reduction of carbonic acid content in blood was observed in 27.0% (95% CI 18.3-38.1%) of patients. The improvement of gas exchange and ventilation function was the following: VC in 14.9% of patients (95% CI 8.5-24.7%), РаО2 – in 24.3% (95% CI 16.0-35.2%) and SаO2 – in 20.3% (95% CI 12.7-30.8%) of patients. Patients remained stable due to moderate intensity of changes. Frequency of negative and positive functional changes after installation of endobronchial valve for valve bronchial blocking (VBB) varies to some extent depending on the place of EV installation, volume of VBB and dissemination of tuberculous lesions. Lower installation of VBB versus upper one: VC increases more rarely (in 8.3 and 21.6% of patients, p < 0.05 respectively), FEV1 decreases more often (in 41.7 and 13.5% of patients p < 0.05 respectively), VC, PEF, РаО2 and SаO2 go down more often (p < 0.05). If tuberculous lesions are limited the cases when pulmonary ventilation capacity decreases after EV installation occur more often compared to disseminated tuberculous lesions and the cases when pulmonary ventilation capacity improves were observed only in case of the disseminated disease.
Highlights
Цель исследования: изучить изменения вентиляционной и газообменной ф ункций легких до и через 1-1,5 мес. после установки эндобронхиального клапана (ЭК) для лечения каверн у больных деструктивным туберкулезом легких
Reduction of pulmonary ventilation capacity due to large bronchi obstruction, restrictive changes and pulmonary gas exchange were manifested through reduction of F E V 1 in 18.9% of patients, P E F - in 20.3%, VC - in 22.9% and PaO 2- in 32.4% of patients
Reduction of carbonic acid content in blood was observed in 27.0% of patients
Summary
Обследовано 74 больных деструктивным ту беркулезом легких (фиброзно-кавернозный ту беркулез - 54 человека, крупные туберкулема(ы) с распадом - 6, кавернозный туберкулез - 7, инфильтративный туберкулез с распадом - 7), кото рым была выполнена КББ. Критерии включения: длительность заболевания туберкулезом не более 6 лет, наличие множественной и широкой лекар ственной устойчивости возбудителя; стабилизация процесса на фоне химиотерапии и пневмоперитонеума (ПП), абациллирование или олигобактериовыделение, исчерпанные возможности химио терапии и ПП для закрытия каверн(ы). Критерии исключения: резекционные операции на легких, на личие ВИЧ-инфекции или декомпенсации любых систем организма. В соответствии с локали зацией деструктивных изменений всем больным проведена установка одного ЭК Всем больным на фоне сформированного ПП проводили первичный (за 2-5 дней до установки ЭК) и повторный После уста новки ЭК) функциональный контроль, включав ший такие доступные и широко используемые мето ды, как исследование вентиляционной способности легких и анализ газового состава крови. Исследование газового состава крови включало определение напряжения кислорода и двуокиси углерода (РаО2, РаСО2) и насыщения кислородом ^ а О 2) артериализованной капилляр ной крови. ТопографияустановкиэКиобъемКББ ( количествоперекрытыхсегментов ) уобследованныхпациентов Table 1. place of E v installation and volume of valve bronchial blocking (number of blocked segments) in the examined patients
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