急性呼吸窘迫综合征患者支气管镜肺活检  

Transbronchial lung biopsy for ARDS patients

作　　者：农凌波[1] 李时悦[1] 何为群[1] 曾运祥[1] 刘晓青[1] 黎毅敏[1] 肖正伦[1] 

机构地区：[1]广州医学院第一附属医院(广州市呼吸疾病研究所),广东广州510120

出　　处：《中国内镜杂志》2009年第5期462-465,共4页China Journal of Endoscopy

摘　　要：目的评估急性呼吸窘迫综合征(ARDS)患者进行支气管镜肺活检(TBLB)的安全性和诊断价值。方法回顾性分析2003年1月～2007年9月在广州呼吸疾病研究所ICU做TBLB检查的8例ARDS患者的临床资料。结果4例(50%)患者经TBLB确诊。侵袭性肺曲霉菌感染1例(12.5%)、放射性肺炎1例(12.5%)、混合性结缔组织疾病肺间质纤维化表现1例(12.5%)、肺结核1例(12.5%)。ARDS患者非特异性病理改变4例(50%)。3例(37.5%)患者因此更改了治疗方案。TBLB的并发症包括:出血<30mL者5例(62.5%)、出血≥30mL者3例(37.5%)、低氧血症7例(87.5%)、低血压3例(37.5%)、心跳过速1例(12.5%)、无气胸及患者死亡。结论在ARDS患者进行支气管镜肺活检有一定风险和诊断价值,在严格掌握适应证的情况下,可以作为肺活检选择。[Objective] To evaluate the safety and diagnostic value of transbronchial lung biopsy （TBLB） performed in acute respiratory distress syndrome （ARDS） patients. [Methods] TBLB was performed in 8 mechanically ventilated ARDS patients from January 2003 to September 2007 in the ICU of Guangzhou Institute of Respiratory Diseases. The results of clinical data were retrospectively analyzed. 8 patients were analyzed. [Results] Specific diagnoses were made with the transbronehial lung biopsies in 4 cases （50%）. The diseases included pulmonary aspergillus pneumonia in 1 cases （12.5%）, radioactive pneumonia in 1 ease （12.5%）, pulmonary interstitial fibrosis of mixed connective tissue disease in 1 case （12.5%） and pulmonary tuberculosis in 1 case （12.5%）. ARDS lung tissue nonspecifie changes were found in 4 cases （50%）. The treatment was changed according to the result of TBLB in 3 patients （37.5%）. Complications associated with this procedure included the following： bronchial hemorrhage 〈30 mL in 5 （62.5%） episodes, bronchial hemorrhage ≥30 mL in 3 （37.5%） cases, transient oxygen desaturation in 7 cases （87.5%）, hypotension in 3 cases （37.5%）, and taehycardia in 1 （12.5%） case. There were no deaths nor episodes of pneumothorax. [Conclusions] Transbronchial lung biopsy can be performed safely and has a diagnostic value in ARDS patients. TBLB should be considered as a diagnostic procedure for lung biopsy.

关 键 词：急性呼吸窘迫综合征 支气管镜肺活检 机械通气 

分 类 号：R563.8[医药卫生—呼吸系统]