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目的探讨生物性肺减容术糜蛋白酶代替胰蛋白酶的合适剂量、国产生物蛋白胶中纤维蛋白原与凝血酶的最佳配比。方法8名慢性阻塞性肺疾病(COPD)患者分别标记1-8。用不同剂量(A,B两种)糜蛋白酶和不同配比(A’,B’两种)生物蛋白胶配伍加上小牛血清通过纤维支气管镜给药。观察术前、术后1周,术后1、3个月肺部影像学改变及测定肺容积,术后3个月时经纤维支气管镜活检组织,观测形态学及病理改变。结果使用糜蛋白酶剂量较小的1,2号患者3个月后靶肺段无显著缩小,质地柔软,病理未见肺组织纤维化改变;7、8号患者右肺/总肺容积下降,且靶肺段纤维组织增生,光镜下病理可发现纤维结构生成炎细胞。结论经纤维支气管镜肺减容术中糜蛋白酶可以替代胰蛋白酶,糜蛋白酶B+小牛血清+B型生物蛋白的用药方法可促使目标肺段萎陷并纤维增生,而完成肺减容。
Objective To investigate the optimal dose of fibrinolytic enzyme and thrombin in domestic biological protein glue for the purpose of investigating the appropriate dose of chondroplasia instead of trypsin for biological lung volume reduction. Methods Eight chronic obstructive pulmonary disease (COPD) patients were labeled 1-8. With different doses (A, B two kinds) chymotrypsin and different proportions (A ’, B’ two kinds) biological protein glue compatibility plus bovine serum by fiberoptic bronchoscopy. The changes of lung imaging and lung volume were observed before operation, 1 week after operation, and 1 month and 3 months after operation. The bronchoscopic biopsy was performed at 3 months after operation to observe the morphological and pathological changes. Results No significant reduction of target lung segment was found in patients with small dose of chymotrypsin 1 and 3 after 3 months. The soft tissue was soft and the pathological changes of lung tissue were not observed. The volume of right lung and total lung in patients of 7 and 8 decreased Target lung segment fibrous tissue hyperplasia, light microscopy pathology can be found in the fibrous structure of inflammatory cells. Conclusion Chymotrypsin can replace trypsin in lung volume reduction surgery. The treatment of chymase B + bovine serum + B type biological protein can promote collapse and fibrosis of target lung segment, and complete lung volume reduction.