Safety and tolerability of sputum induction in adolescents and adults with suspected pulmonary tuberculosis
Safety and tolerability of sputum induction in adolescents and adults with suspected pulmonary tuberculosis
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DOI：
10.1007/s10096-011-1344-5
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发表时间：
2012-04-01
影响因子：
4.5
通讯作者：
Hatherill, M.
中科院分区：
文献类型：
--
作者：
Geldenhuys, H. D.;Kleynhans, W.;Hatherill, M.
吸入高渗盐水诱导痰可提高肺结核（TB）的微生物诊断率。这在少杆菌性结核病中尤其重要，例如儿童或人类免疫缺陷病毒（HIV）感染患者。在没有侵入性诊断方法的社区环境中，必须证明诱导痰是安全和可容忍的。本研究的目的是描述在社区诊所招募的流动成人和青少年结核病疑似患者在诱导痰过程中发生的生理参数变化和不良事件。对艾滋病毒感染者（n = 35）和未感染艾滋病毒者（n = 67）肺结核疑似患者（n = 102）进行痰诱导。在基线时监测血氧饱和度（%）、血压（mm Hg）、心率（/分钟）、呼吸频率（/分钟）和不良事件，在沙丁胺醇预处理和生理盐水雾化阶段持续监测，并在治疗后监测30分钟。在雾化过程中，氧饱和度（1%,p < 0.0001）、收缩压（7 mm Hg, p < 0.0001）和舒张压（2 mm Hg, p = 0.008）均有统计学意义的升高。雾化后收缩压降低（4mmhg, p = 0.016）。这些变化被认为没有临床意义。8例轻微的、短暂的、自行解决的不良事件发生（呼吸困难，n = 2；胸痛，n = 2；阵发性咳嗽，n = 1；心率升高，n = 1；呕吐，n = 1；低血压，n = 1），导致4例患者手术终止。未发生严重不良事件。在社区卫生保健机构中，诱导痰对成人和青少年结核病疑似患者是安全、可耐受和可行的。
Sputum induction by the inhalation of hypertonic saline may increase the yield of microbiological diagnosis of pulmonary tuberculosis (TB). This is particularly relevant in paucibacillary TB, such as in children or human immunodeficiency virus (HIV)-infected patients. Sputum induction must be shown to be safe and tolerable in community settings where invasive diagnostic methods are unavailable. The objective of this study was to describe the changes in physiological parameters and adverse events occurring during sputum induction in ambulatory adult and adolescent TB suspects recruited in community clinics. Sputum induction was performed in HIV-infected (n = 35) and HIV-uninfected (n = 67) TB suspects (n = 102). Oxygen saturation (%), blood pressure (mm Hg), heart rate (/minute), respiratory rate (/minute), and adverse events were monitored at baseline, continuously during the salbutamol pre-treatment and saline nebulization phases, and for 30 min afterwards. During nebulization, there was a statistically significant increase in oxygen saturation (1%, p < 0.0001), systolic BP (7 mm Hg, p < 0.0001), and diastolic BP (2 mm Hg, p = 0.008). Post-nebulization decrease in the systolic BP occurred (4 mm Hg, p = 0.016). These changes were not considered to be clinically significant. Eight minor, transitory, self-resolving adverse events occurred (labored breathing, n = 2; chest pain, n = 2; paroxysmal coughing, n = 1; elevated heart rate, n = 1; vomiting, n = 1; hypotension, n = 1), leading to procedure termination in four participants. No serious adverse events occurred. Induced sputum is safe, tolerable, and feasible in adult and adolescent TB suspects in a community healthcare setting.