肺超声可视化支气管肺泡灌洗在肺外周病灶诊断中的应用  

Application of lung ultrasound visualization bronchoalveolar lavage in the diagnosis of peripheral lung lesions

作　　者：王斌 王静 黄赞胜 王苹 王创业 张硕辛 秦蘅 孙晓容 吴红梅 胡晋 杨昱 张明周 李力[2] 徐智 Wang Bin;Wang Jing;Huang Zansheng;Wang Ping;Wang Chuangye;Zhang Shuoxin;Qin Heng;Sun Xiaorong;Wu Hongmei;Hu Jin;Yang Yu;Zhang Mingzhou;Li Li;Xu Zhi(Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Army Medical University,Chongqing 400037,China;Department of Respiratory Medicine,Daping Hospital,Army Medical University(Third Military Medical University),Chongqing 400042,China)

机构地区：[1]陆军(第三)军医大学第二附属医院呼吸与危重症医学中心,重庆400037 [2]陆军(第三)军医大学陆军特色医学中心呼吸与危重症医学科,重庆400042

出　　处：《中华肺部疾病杂志（电子版）》2023年第4期466-470,共5页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：重庆市科卫联合医学科研项目(2020FYYX179);重庆市自然科学基金面上项目(CSTB2022NSCQ-MSX1110)。

摘　　要：目的 分析超声实时监测可视化支气管肺泡灌洗(bronchoalveolar lavage, BAL)在肺部疾病诊断中的应用。方法 选择2022年1月至2022年12月我科118例有明确肺外周病灶的患者,在超声实时监测下进行常规支气管肺泡灌洗,根据支气管肺泡灌洗可视化图像调整灌洗量直至目标肺段液体充盈显影再回收灌洗液。针对目标肺段所处重力依赖区或非重力依赖区调整灌洗体位及引流体位,增加灌洗液回收率,比较常规与超声可视化BAL的支气管肺泡灌洗液(bronchoalveolar lavage fluid, BALF)对肺部疾病诊断的阳性率。结果 118例患者中肺癌65例,肺部感染53例。病灶位于重力低位区64例,非重力低位区54例。常规灌洗目标病灶超声显影率48.3%,超声可视化BAL目标病灶超声显影率78.8%。可视化BAL右上叶、右中叶、右下叶、左上叶、左下叶目标病灶显影所需灌洗液量分别为(101.5±19.1 m、76.3±11.3 ml、68.6±9.9 ml、97.1±11.6 ml、70.4±12.0 ml),配合体位调整各肺叶灌洗液回收率分别为(58.1%、59.8%、61.0%、58.8%、59.9%)。可视化BALF的病理阳性率显著高于常规支气管肺泡灌洗(70.8%vs. 27.7%,P<0.05),病原学检测阳性率也显著高于常规支气管肺泡灌洗(64.2%vs. 33.9%,P<0.05)。结论 肺超声可视化BAL结合体位调整可提高BALF回收率及检测阳性率,在肺外周病灶诊断中具有临床意义。Objective To analyze the application of real-time ultrasound monitoring and visualization of bronchoalveolar lavage in the diagnosis of lung diseases.Method From January 2022 to December 2022,118 patients with definite peripheral lung lesions in our department were selected for routine bronchoalveolar lavage under real-time ultrasound monitoring,the lavage volume was adjusted according to the visualization image of bronchoalveolar lavage until the target lung segment was filled and developed,and then the lavage fluid was recovered.Adjusting the lavage position and drainage position according to the gravity-dependent area or non-gravity-dependent area where the target lung segment is located,increasing the recovery rate of lavage fluid,and comparing the positive rate of bronchoalveolar lavage fluid with conventional and ultrasonic visualization BAL in the diagnosis of lung diseases.Results Among the 118 patients,there were 65 lung cancer cases and 53 pulmonary infection cases.64 cases with the lesions located in gravity low area while 54 cases in non-gravity low area.The ultrasonic imaging rate of the target lesions in routine lavage was 48.3%,and the imaging rate of target lesions in ultrasonic visualization BAL was 78.8%.The amount of lavage fluid required for visualization BAL of target lesions in right upper lobe,right middle lobe,right lower lobe,left upper lobe and left lower lobe are 101.5±19.1 m,76.3±11.3 ml,68.6±9.9 ml,97.1±11.6 ml,and 70.4±12.0 ml,respectively,the recovery rate of each lung lavage fluid coordinating with posture adjustment is 58.1%,59.8%,61.0%,58.8%,59.9%.The pathological positive rate of visual BALF was significantly higher than that of conventional bronchoalveolar lavage(70.8%vs.27.7%,P<0.05),the positive rate of pathogen detection was also significantly higher than conventional bronchoalveolar lavage(64.2%vs.33.9%,P<0.05).Conclusion Pulmonary ultrasound visualization BAL combined with posture adjustment during lavage can improve the recovery rate and positive rate of BALF,which h

关 键 词：肺超声 支气管肺泡灌洗 可视化 肺外周病灶 阳性率 

分 类 号：R563[医药卫生—呼吸系统]