摘要
目的:分析超声电导仪经皮局部透药联合药物治疗复治肺结核的临床效果及疗效影响因素。方法:选取医院收治的160例复发肺结核患者,依据治疗方法的不同将其分为观察组(120例)和对照组(40例),对照组给予常规抗结核药物治疗,观察组在接受常规抗结核药物治疗的同时给予超声电导仪经皮局部透药治疗。治疗3个月后评估两组患者疗效,观察并比较两组患者不良反应发生情况,应用世界卫生组织生存质量测定量表简化版(WHOQOL-BREF)评估两组患者生活质量;再将观察组120例患者依据治疗结局不同分为有效组和无效组,每组60例,比较不同疗效患者年龄、性别、临床症状、痰菌检查、痰菌分级等指标,采用多因素Logistic回归分析复治肺结核患者疗效不佳的影响因素。结果:观察组患者治疗总有效率为85.50%,明显高于对照组的67.50%,差异有统计学意义(x2=4.033,P<0.05)。观察组和对照组患者治疗后生理、心理、社会关系及生活环境领域评分水平明显高于同组治疗前(t对照组=12.735,t=13.565,t=12.040,t=6.435;t观察组=12.050,t=14.815,t=9.065,t=7.125;P<0.05);其中观察组治疗后生理、心理及社会关系评分水平均明显高于对照组,差异具有统计学意义(t=3.168,t=3.794,t=5.016;P<0.05),而治疗后生活环境领域评分比较,差异无统计学意义。观察组和对照组不良反应发生率比较,差异无统计学意义。观察组中的有效组患者年龄<60岁、临床症状<4种、无咳血或血痰、无空洞、无合并症、痰菌检查涂阴以及治疗后2个月末痰检阴性比例均明显高于无效组(x2=3.980,x2=7.031,x2=5.027,x2=3.922,x2=7.478,x2=6.554,x2=6.011;P<0.05)。多因素Logistic回归分析中,年龄≥60岁、临床症状≥4种、咳血或血痰、空洞、合并症、痰菌涂阳以及2个月末痰检阳性均是复治肺结核患者疗效不佳的影响因素(OR=0.492,OR=0.426,OR=0.468,OR=0.416,OR=0.225,OR=0.395,OR=0.457;P<0.05)。结论:超声电导仪经皮局部透药联合药物治疗复治肺结核疗效较好,且具有良好安全性,有助于改善患者生活质量。年龄、临床症状、咳血或血痰、空洞、合并症、痰菌检查以及治疗后2个月末痰检等均是复治肺结核患者疗效的影响因素,早期评估影响因素可对评估患者预后、给予针对性治疗提供帮助。
Objective: To analyze the clinical effect and influencing factors of transcutaneous local drug penetration of ultrasound conductance instrument combined with drugs in treating retreated pulmonary tuberculosis. Methods:160 patients with recurrent pulmonary tuberculosis admitted to the hospital were selected and they were divided into the observation group(120 cases) and the control group(40 cases) according to the different treatment methods. The control group was treated with conventional anti-tuberculosis drugs, while the observation group was treated with percutaneous local drug penetration treatment of ultrasound conductance instrument on the basis of conventional antituberculosis drugs. After 3 months of treatment, the curative effects of two groups were assessed, and the occurrences of adverse reactions of patients between two groups were observed and compared. The simplified version of World Health Organization Quality of Life Measurement Scale(WHO QOL-BREF) was used to assess the quality of life of two groups. 120 patients of observation group were further divided into effective group and ineffective group according to different treatment outcomes, with 60 patients in each subgroup. The age, gender, clinical symptoms, sputum bacteria examination, sputum bacteria grading and other indicators of patients between different curative effects were compared, and the influencing factors of poorly curative effect of patients whose pulmonary tuberculosis were retreated were analyzed by multivariate Logistic regression. Results: The total effective rate of treatment in the observation group was 85.50%, which was significantly higher than 67.50% in the control group(x~2=4.033, P<0.05). The scores in the fields of physiology, psychology, social relations and living environment in the two groups after treatment were significantly higher than those before treatment(tcontrol group=12.735, t=13.565, t=12.040, t=6.435, tobservation group=12.050,t=14.815, t=9.065, t=7.125, P<0.05). The scores of physical, psychological and social relations after treatment in the observation group were significantly higher than those in the control group(t=3.168, t=3.794, t=5.016, P<0.05),respectively, while there was no significant difference between the two groups in the score of living environment after treatment. There was no significant difference in the incidence of adverse reactions between the two groups. The ratios of age <60 years old, the number of clinical symptoms <4, without hemoptysis or bloody sputum, without cavity,without complication, negative sputum smear, sputum test negative at the end of 2 months after treatment of effective group were significantly higher than those in the ineffective group(x~2=3.980, x~2=7.031, x~2=5.027, x~2=3.922, x~2=7.478,x~2=6.554, x~2=6.011, P<0.05), respectively. The results of multivariate Logistic regression analysis showed that age ≥60 years old, the number of clinical symptoms ≥ 4, hemoptysis or blood sputum, cavities, complications, sputum smear positive and sputum test positive at the end of 2 months after treatment were the influencing factors of poorly curative effect of patients with pulmonary tuberculosis who were retreated(OR=0.492, OR=0.426, OR=0.468, OR=0.416,OR=0.225, OR=0.395, OR=0.457, P<0.05). Conclusion: Transcutaneous local drug penetration of ultrasound conductance instrument combined with drugs has better curative effect for retreated pulmonary tuberculosis, and has favorable safety, which contributes to improve the quality of life of patients. Age, clinical symptoms, hemoptysis or blood sputum, cavities, complications, sputum bacteria examination, sputum examination at the end of 2 months after treatment are influence factors that affects the curative effect of patients with pulmonary tuberculosis who are retreated. The early assessment of the influencing factors may provide a certain of help in assessing the prognosis of patients and conducting treatment with pertinence.
作者
张焕
王勇
陈素丽
安贺娟
贡小昕
王显雷
刘锐
HANG Huan;WANG Yong;CHEN Su-li(Department of Respiratory Tuberculosis,Hebei Chest Hospital,Shijiazhuang 050041,China;不详)
出处
《中国医学装备》
2023年第1期82-86,共5页
China Medical Equipment
基金
河北省医学科学研究重点课题(20160494)“超声电导仪药物透入治疗复治肺结核的应用价值”。
关键词
超声电导仪经皮局部透药
药物治疗
肺结核
临床效果
影响因素
Transcutaneous local drug penetration of ultrasound conductance instrument
Drug therapy
Pulmonary tuberculosis
Clinical effect
Influence factors
