全肺灌洗术治疗尘肺临床效果观察.docVIP

全肺灌洗术治疗尘肺临床效果观察 　 作者：敬梅，江玲，南萍，王永兴，谢晓燕 【摘要】 　　目的 探讨全肺灌洗术治疗尘肺病的临床效果。方法 对10例不同期别的尘肺病患者，在静脉复合麻醉下进行双腔支气管插管，并将双肺成功隔离，一侧肺纯氧通气，一侧肺采用灌洗液反复灌洗，并于灌洗前及灌洗后分别测定血气、肺功能。全肺灌洗治疗后动脉血氧分压与治疗前对比其改变有统计学意义(Plt;0．05)；相反，动脉血二氧化碳分压、肺通气功能以及肺弥散功能灌洗治疗前后均无统计学意义(Pgt;0．05)。结果 成功进行双肺同期肺灌洗10例，术中顺利，术后临床症状消失，无明显术后并发症。结论 全肺灌洗术疗效好、安全，并发症发生少，是治疗尘肺病安全、有效的治疗方法之一。 【关键词】 尘肺病； 尘肺；灌洗术；双肺同期 　　Abstract： Objective To explore the clinical outcomes of whole lung lavage for the therapy of pneumoconiosis. Methods Ten patients with pneumoconiosis at various stage were performed doublelumen endotracheal intubation under the condition of combined intravenous anesthesia, and the bilateral lungs were successfully isolated from each other. Ventilation with oxygen (Fi=1.0) was carried out to one lateral lung and repeated lavage was meanwhile conducted to the other lateral lung. In the end, both the bilateral lungs were given lavage. Blood gas and lung function were detected before and after lavage. The change in arterial partial pressure of oxygen (PaO2) after lavage was statistically significant when it was compared with that before whole lung lavage (Plt;0.05). On the contrary, there were no obvious differences in arterial partial pressure of carbon dioxide (PaCO2) and lung ventilatory or diffuse fuction between before and after lavage (Pgt;0.05). Results Successful bilateral lung lavage was conducted in the ten patients without obvious postoperative complications. Conclusion Whole lung lavage is effective on pneumoconiosis with safety or few complications. 　　Key words： pneumoconiosis; total lung lavage; therapy 　　尘肺是我国法定职业病之一，常见于接触粉尘的某些职业，严重影响工人的身体健康。因长期吸入大量能引起肺纤维化病变的各种粉尘所引起，粉尘沉降于肺内会导致巨噬细胞不断地吞噬裂解，破裂的巨噬细胞又会释放成纤维因子，导致胶原纤维增生，从而使尘肺的病变不断缓慢进展。临床症状主要为进行性胸闷气短、胸痛、咳嗽、咳痰等，且易发生呼吸道及肺部感染，晚期引起肺源性心脏病及呼吸衰竭，最后完全丧失劳动能力并危及生命。目前尘肺的治疗主要采用肺灌洗、药物及中医中药等综合性治疗措施。能早期灌洗清除患者肺内的粉尘和部分含尘巨噬细胞，有利于抑制病变的进展。现将我们近2年来取得满意效果的10例大容量肺灌洗术报告如下。 　　1 资料与方法 　　1.1 一般资料 　　10例患者均为男性，年龄27～58岁，平均42岁；身高155～178 cm，体重60～88 kg。尘肺病的诊断按照《尘肺病诊断标准(GBZ 702002)》[1]，均经职业病诊断机构诊断明确,其中