支气管镜术后发热的临床分析

Clinical analysis of fever after bronchoscopy

摘要:

目的 探讨支气管镜诊疗术种类与术后发热的关系。方法 选取2019年1月－2019年6月中日友好医院呼吸中心临床诊察部行支气管镜诊疗术的患者1 390例，排除门诊和胸外科患者119例、仅探查或仅吸痰患者30例，共纳入对象1 241例。按支气管镜介入手术项目及频次，分为单项手术组（n = 428）和多项手术组（n = 813），根据支气管肺泡灌洗（BAL）情况分为未行BAL组（n = 173）、单部位BAL组（n = 878）和多部位BAL组（n = 190），比较各种临床分组间的术后发热率。结果 该组患者总发热率为5.88%，单项手术组和多项手术组总发热率比较，差异无统计学意义（P > 0.05）；肺部感染性疾病患者发热比例为10.13%，高于非肺部感染性疾病患者发热率3.97%（P < 0.05）。其中，肺部感染性疾病中单部位BAL与多部位BAL发热率比较，差异无统计学意义（P > 0.05），而在肺部非感染性疾病中，多部位BAL总发热率（9.62%）明显高于单部位BAL总发热率（3.21%）（P < 0.05）。56例感染发热患者中，30例病原学阳性，其中结核分枝杆菌感染最多，其次是曲霉菌和病毒感染。非感染发热的患者中多为免疫功能低下。结论 支气管镜诊疗项目数不会增加发热概率，肺部感染性疾病（结核、曲霉和病毒）可增加发热概率，非感染性疾病中多部位BAL操作易导致发热。

Abstract:

Objective To investigate the relationship between the types of bronchoscopic interventions and fever.Methods 1 390 patients with bronchoscopy from January 2019 to June 2019, excluding outpatient patients and department of thoracic surgery (n = 119) and only probe or sputum aspiration (n = 30), 1 241 cases eventually included. The subjects were divided into two groups according to the surgical items and frequency of bronchoscopy: 428 cases in single operation group and 813 cases in multiple operation group. According to the bronchoalveolar lavage condition, 173 cases were divided into non-lavage group, 878 cases in one segment lavage group and 190 cases in multiple segments lavage group. The differences between varied clinical characteristics were compared.Results The total fever rate was 5.88%. There was no statistical difference between the single interventional operation group and the multiple interventional operation group (P > 0.05). The fever rate of pulmonary infectious diseases was 10.13%, which was higher than that of non-infectious diseases (3.97%) (P < 0.05). The fever rate of single-segment BAL group was not significantly different from that of multi-segments BAL group in pulmonary infectious diseases, but in pulmonary non-infectious diseases. The rate of fever in multi-segments BAL (9.62%) was significantly higher than that of single-segment BAL (3.21%) (P < 0.05). Among 56 patients with fever, 30 had positive etiology. The most common pathogen was Mycobacterium tuberculosis, followed by aspergillus and viral infections. Non-infectious patients with fever were mostly immunocompromised patients.Conclusion The frequency of bronchoscopic interventional operation do not increased the risk of fever, while pulmonary infectious diseases (tuberculosis, aspergillus and virus) can increase the risk of fever, non-infectious diseases in the multi-segments BAL operation can easily cause fever.