经纤维支气管镜大容量全肺灌洗法的建立及与传统肺灌洗术的比较  

Establishment of transbronchoscope whole lung lavage and its comparison with bronchoalveolar lavage and whole lung lavage

作　　者：肖雄斌 张晓华 李颖 戴伟荣 李欣 严薇 唐美岸 唐细良 

机构地区：[1]湖南省职业病防治院职业病科,长沙410007

出　　处：《中华劳动卫生职业病杂志》2015年第11期830-833,共4页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：湖南省科技厅重点科研项目：尘肺治疗新方法的研究（2011SK2020）

摘　　要：目的 建立经纤维支气管镜大容量全肺灌洗术（TBWLL）的技术规范并探讨与支气管肺泡灌洗术（BAL）、大容量全肺灌洗术（WLL）治疗尘肺的临床疗效.方法 将湖南省职业病防治院2009至2014年收治的尘肺病患者133例按照灌洗方式不同分为TBWLL组43例,BAL组和WLL组各45例.TBWLL组在经典的支气管肺泡灌洗技术的基础上,配合镇静、麻醉等技术改良,在纤维支气管镜直视下每次灌洗双侧肺,每个疗程灌洗2次,灌洗量与传统的BAL及WLL进行对比,并对其治疗前后的临床症状、肺功能、血气及安全性进行评价.结果 TBWLL组肺灌洗术后咳嗽及活动受限症状明显改善,与治疗前比较,差异有统计学意义（P＜0.05）;与BAL组比较,TBWLL组分次灌洗量及总灌洗量明显增加,住院时间缩短,差异有统计学意义（P＜0.05）.3组患者肺灌洗治疗后近期临床症状及肺功能无明显变化,TBWLL组和WLL组较BAL组术后并发症低,差异有统计学意义（P＜0.05）.结论 经TBWLL临床效果佳,兼具BAL、WLL的优点,适应性、安全性及有效性较高。Objective To establish the technical specifications of transbronchoscope whole lung lavage （TBWLL） and to compare the clinical efficacy between TBWLL and bronchoalveolar lavage （BAL） or whole lung lavage （WLL）.Methods A total of 133 patients with pneumoconiosis admitted to Hunan Prevention and Treatment Institute for Occupational Diseases from 2009 to 2014 were divided into TBWLL group （n=43）,BAL group （n=45）,and WLL group （n=45）.Patients in the TBWLL group received conventional BAL of both lungs under a fiber bronchoscope,as well as sedation and anesthesia;lavage was performed twice in each course.TBWLL was compared with the BAL and WLL in terms of lavage volume.The clinical symptoms,pulmonary function,and blood gas before and after treatment and the safety were evaluated.Results The TBWLL group had significantly relieved cough and limitation of activity after lavage （P〈0.05）.Compared with the BAL group,the TBWLL group had significantly increased single lavage volumes and total lavage volume and a significantly shortened length of hospital stay （P〈0.05）.The three groups showed no significant short-term changes in clinical symptoms and pulmonary function after lavage.The TBWLL and WLL groups had a significantly lower incidence of postoperative complications than the BAL group （P〈0.05）.Conclusion TBWLL has good clinical efficacy,with the advantages of BAL and WLL,and is highly feasible,safe,and effective.

关 键 词：尘肺 支气管镜 支气管肺泡灌洗 

分 类 号：R135.2[医药卫生—劳动卫生]