重复全肺灌洗术治疗矽肺的远期疗效  

The long-term therapeutic effects of silicosis by repeat the whole lung lavage

作　　者：张映铭[1] 王伟[1] 王彩英[1] 张海涛[1] 吴静[1] 王春[1] 方申存[1] 

机构地区：[1]南京市胸科医院,210029

出　　处：《中华劳动卫生职业病杂志》2013年第9期681-684,共4页Chinese Journal of Industrial Hygiene and Occupational Diseases

摘　　要：目的 探讨重复全肺灌洗（RWLL）治疗矽肺的远期效果.方法 选择在同一石材矿区作业的60例矽肺患者,根据年龄、矽肺期别、接尘工龄等按1∶1比例随机分为RWLL组与全肺灌洗（WLL）组,进行远期疗效和安全性对比观察,并对RWLL组二次右肺支气管肺泡灌洗回收液（BALF）进行细胞学和SiO2含量测定.结果 治疗4年后,RWLL组咳嗽、气喘好转率分别为68.4％、75.0％,高于WLL组（52.4％、57.9％）,但差异无统计学意义（P＞0.05）.治疗6年后,RWLL组气喘好转率为70.0c％,明显高于WLL组（36.8％）,差异有统计学意义（P＜0.05）.RWLL组治疗6年后用力肺活量（FVC）与第1秒用力呼气量（FEV1.0）比治疗前逐渐下降,但差异无统计学意义（P＞0.05）;治疗6年后WLL组,FVC与 FEV1.0比治疗前明显下降,差异有统计学意义（P＜0.05）.治疗4、6年后,RWLL组X线胸片无变化率高于WLL组,进展与明显进展率低于WLL组,两组比较,差异均无统计学意义（P＞0.05）.RWLL组第1次右肺BALF检查：细胞数为6.71×107～2.14×109/L,平均4.50×108/L;肺泡巨噬细胞（PAM）比率为0.873～0.980,平均0.954;SiO2含量18～104.7 mg,平均93.7 mg.第2次BALF检查：细胞数为5.71×106～1.30×109/L,平均为9.12×107/L;PAM比率0.710～0.926,平均0.870;SiO2含量6～90.2 mg,平均46.2 mg.RWLL组围手术期发生痰血,胸痛各1例,发生率6.7％.在随访1年中,RWLL组并发左侧气胸,肺部感染各1例;WLL组并发肺部感染1例.结论 RWLL治疗矽肺不仅合理而且安全,并有助于进一步提高WLL治疗矽肺的远期疗效.objective To preliminary study the long term therapeutic effects of repeat the whole lung lavage （RWLL） in the treatment of silicosis.Methods A total of 60 patients with silicosis in the same stone mine were randomly and equally divided into repeat the whole lung Lavage （RWLL） group and whole lung Lavage （WLL） group based on silicosis staging,age and working age of dust exposure.Comparative analysis was performed to evaluate the long-term therapeutic efficacy and safety of RWLL.The cell count and SiO2 content were measured in twice right lung bronchoalveolar lavage fluid（BALF） of the RWLL group.Results Four years after treatment,the cough and asthma improvement rates of the RWLL group were 68.4％ and 75.0％ higher than those （52.4％ and 57.9％） of the WLL group （P＞0.05）.Six years after treatment,the asthma improvement rate （70.0％） of the RWLL group was significantly higher than that （36.8％） of the WLL group （P＜0.05）.The RWLL group showed slight decrease in forced vital capacity （FVC） and forced expiratory volume in one second （FEV1.0） after treatment （P＞0.05）,while the WLL group showed significant decrease in FVC and FEV1.0 in the six years after treatment （P＜0.05）.Four and Six years after treatment,the RWLL group had higher no change rate and lower progression rate and significant progression rate than the WLL group in terms of chest Xray （P＞0.05）.In the RWLL group,the first time the right lung BALF test showed a number of cells 6.71 ×107～2.14× 109/L,average 4.50×108/L,pulmonary alveoli macrophages （PAM） ratio of 0.873～0.980,average 0.954and SiO2 content of 18～104.7 mg.average 93.7 mg; the second test showed a number of cells 5.71×106～1.30×109/L,average 9.12× 107/L; PAM ratio 0.710～0.926,average 0.870 and SiO2 content of 6～90.2 mg,average 46.2 mg.The RWLL group happened hemoptysis 、chest pain one case in perioperative period,the incidence of 6.7％.The RWLL group complicated by left pneumothorax、pulmonary infectio

关 键 词：矽肺 重复全肺灌洗术 远期疗效 

分 类 号：R135.2[医药卫生—劳动卫生]