河西学院学报

目的：探讨局部灌注乙酰半胱氨酸联合AI辅助支气管镜治疗老年支气管扩张伴感染的临床效果，对比乙酰半胱氨酸不同给药方式的疗效差异。方法：选取174例老年支气管扩张伴感染患者，按照随机数表法分为对照组(58例)、局部灌注组(58例)与雾化组(58例)。对照组采用常规药物治疗，局部灌注组行AI辅助支气管镜精准灌洗+局部灌注乙酰半胱氨酸，雾化组行AI辅助支气管镜精准灌洗+氧化雾化乙酰半胱氨酸，三组均同步实施抗感染治疗，对比临床疗效、炎症因子、肺功能及安全性，通过16SrRNA测序分析气道菌群变化。结果：局部灌注组、雾化组总有效率(96.55%、93.10%)均高于对照组(79.31%,P<0.05)；局部灌注组咳痰缓解(6.42±1.95d)、咳嗽消失时间(6.13±1.74d)短于雾化组(7.58±2.12d、7.35±2.08d,P<0.05)；治疗结束后，局部灌注组与雾化组的IL-8及TNF-α水平均低于对照组，IFN-γ、FEV₁/FVC高于对照组，且局部灌注组改善更显著(P<0.05)；局部灌注组气道菌群α多样性(Chao1指数：235.7±42.1;Shannon指数：3.21±0.65)高于雾化组及对照组(P<0.05)。不良反应无差异(P>0.05)。结论：AI辅助支气管镜联合乙酰半胱氨酸治疗疗效显著，局部灌注方式在症状缓解、炎症控制及菌群重构上更具优势，为老年患者精准治疗提供新策略。

Objective:To evaluate local acetylcysteine instillation combined with AI-assisted bronchoscopy in older patients with bronchiectasis and infection and to compare local instillation with nebulized administration. Methods:A total of 174 patients were randomly allocated using a random number table to three groups of 58:conventional drug treatment,AI-assisted bronchoscopic lavage with local acetylcysteine instillation,or AI-assisted bronchoscopic lavage with nebulized acetylcysteine.All groups received anti-infective therapy. Clinical response,symptom resolution,inflammatory markers,lung function,and adverse reactions were compared. Airway microbiota were assessed by 16S rRNA sequencing. Results:Overall response rates were higher in the local instillation and nebulization groups than in controls,at 96.55%,93.10%,and 79.31%,respectively(P<0.05). Time to relief of sputum symptoms and time to cough resolution were shorter with local instillation than with nebulization:6.42 ± 1.95 versus 7.58 ± 2.12 days and 6.13 ± 1.74 versus 7.35 ± 2.08 days,respectively(P < 0.05). After treatment,interleukin-8 and tumor necrosis factor-α levels were lower,and interferon-γ levels and FEV1/FVC were higher,in both intervention groups than in controls,with greater improvements in the local instillation group(P < 0.05). Airway microbial alpha diversity was higher in the local instillation group than in the other two groups,with a Chao1 index of 235.7 ± 42.1 and a Shannon index of 3.21 ± 0.65(P < 0.05). Adverse reaction rates did not differ significantly among groups(P > 0.05). Conclusion:Acetylcysteine combined with AI-assisted bronchoscopic lavage improved clinical outcomes in older patients with bronchiectasis and infection. Local instillation produced better symptom relief,inflammatory control,and airway microbial diversity than nebulization.