大容量肺灌洗治疗尘肺病的方法优化研究  

Study of optimization of whole lung lavage applied to pneumoconiosis

作　　者：张悦[1] 毛翎[1] 周韶炜[1] 施瑾[1] 陈子丹[1] 卞陆琴[1] 毕莹[1] 肖和平[1] 

机构地区：[1]同济大学附属上海市肺科医院,上海200433

出　　处：《中华劳动卫生职业病杂志》2012年第11期829-833,共5页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：国家职业病临床重点专科建设项目（2010）

摘　　要：目的观察和评价间歇加压通气、。肾上腺素和加压灌洗在大容量全肺灌洗（WLL）中对残留液体吸收、改善血氧饱和度的影响。方法以150例WLL患者为观察对象，随机分为加压通气组（28例）、肾上腺素组（31例）、加压通气＋肾上腺素组（29例）、加压输液袋组（30例）和对照组（32例），进行两肺分期WLL，比较各组患者的血氧饱和度（SpO2）、X线胸片表现、临床症状、肺功能等。结果各组间各项临床症状改变的差异无统计学意义（P〉0．05），与灌洗前比较，肾上腺素组肺活量（FVC）、25％肺活量流速（FEF）分别升高6．3％和10．9％，差异有统计学意义（P〈0．05）；与灌洗前比较，对照组FVC降低5．7％、第1秒用力呼气量（FEV）和FEF。％分别升高10．9％和12．0％，差异有统计学意义（P〈0．05）。其余各组间指标灌洗前后的差异均无统计学意义（P〉0．05）。灌洗术中、术后，加压通气组、加压通气＋肾上腺素组和对照组的低氧血症发生率分别为0、0和12．5％（8／64），差异有统计学意义（P〈0．01）。各组的灌洗液总量和肺部残留液量的差异无统计学意义（P〉0．05）。加压通气＋肾上腺素组灌洗后3h胸片两侧光密度之差值最低为0．152±0．053，加压通气组为0．194±0．074，加压输液袋组为0．197±0．054，肾上腺素组为0．214±0．054，对照组为0．241±0．109，除肾上腺素组外，其余各组与对照组的差异均有统计学意义（P〈0．05）。结论加压通气、肾上腺素和灌洗液加压联合用于WLL，有利于肺部残留液体的转运吸收，降低低氧血症的发生。Objective To observe and evaluate the performances of intermittent positive pressure ventilation, beta-2 adrenergic receptor agonist, and pressure lavage in promoting residual fluid absorption and improving blood oxygen saturation during massive whole lung lavage （WLL）. Methods A total of 155 patients were randomly divided into pressure ventilation （PV） group （n=28）, adrenaline （Ad） group （n=31 ）, PV plus Ad group （n=29）, pressure infusion bag （PIB） group （n=30）, and control group （n=32）. The patients underwent staged MWLL of bilateral lungs. The blood oxygen saturation （SpO2） of arterial blood of finger, chest X-ray findings, clinical symptoms, and lung functions were observed before and after MWLL. Results There were no significant differences in change in clinical symptoms among the five groups after MWLL （P〉0.05）. The Ad group showed 6.3% increase in forced vital capacity （FVC） and 10.9% increase in forced expiratory flow at 25% of vital capacity （FEF） after MWLL （P〈0.05）. The control group showed 5.7% decrease in FVC, 10.9% increase in forced expiratory volume in one second （FEVr0）, and 12.0% increase in FEFafter MWLL （P〈0.05）. No significant difference was found in other groups （P〉0.05）. During and after MWLL, the incidence rates of hypoxemia in PV group, PV plus Ad group, and control group were O, O, and 12.5% （8/64）, respectively （P〈 0.01 ）. There were no significant differences in total amount of lavage fluid and amount of residual fluid in the lung among all groups （P〉0.05）. The smallest difference between the optical densities of the two lung fields on chest x-ray at 3 h after WLL was 0.152±0.053 in the PV plus Ad group, compared to 0.194±0.074 in the PV group, 0.197±0.054 in the PIB group, 0.214±0.054 in the Ad group, and 0.241±0.109 in the control group, with significant differences between the saline group and other groups except Ad group （P〈0.05）. Conelusion Pressure ventilation, adrenaline, and p

关 键 词：支气管肺泡灌洗 加压通气 低氧血症 Β2受体激动剂 

分 类 号：R135.2[医药卫生—劳动卫生]