肺泡蛋白沉积症患者高氧液肺灌洗术的效果

Lung lavage with hyperoxygenated fluid in patients with pulmonary alveolar proteinosis

对3例患者双侧肺行肺灌洗术,先行左肺灌洗术,1周后再行右肺灌洗术。每侧肺分别用高氧液和乳酸林格氏液交替灌洗,当脉搏血氧饱和度(SpO_2)高于92%时进行肺灌洗术,高氧液和乳酸林格氏液各灌洗10次,取其平均值。测定乳酸林格氏液和高氧液的氧分压；记录灌洗前即刻、灌洗10、20、30、40、50、60、70、80s时SpO_2及平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)和呼吸末二氧化碳分压(P_(ET)CO_2)。左肺灌洗术后1周PaO_2为(72.3±2.1)mm Hg；右肺灌洗术后3d PaO_2为(83.5±4.8)mm Hg。所有患者均顺利出院。高氧液的氧分压[(780±4)mm Hg]高于乳酸林格氏液[(171±6)mm Hg]。与乳酸林格氏液比较,高氧液灌洗10～80s时SpO_2时升高(P＜0.05),MAP、CVP、HR、P_(ET)CO_2差异无统计学意义(P＞0.05)。在氧供方面PAP患者高氧液肺灌洗术的效果优于乳酸林格氏液。

Bilateral lung lavage was performed under general anesthesia with muscle relaxation in 3 patients with pulmonary alveolar proteinosis （PAP） aged 43-57 yrs weighing 48-68 kg. Left lung lavage was performed first and the right lung was lavaged one week later. Left radial artery and right internal jugular vein were cannulated for MAP, HR and CVP monitoring. SpO2 and PEr CO2 were monitored during lavage. Left-sided Robertshaw double-lumen tube was used for both right and left lung lavage. After proper placement of the doublelumen tube was verified both lungs were ventilated with 100% 02 for 10 rain to wash out N2 . Hyperoxygenated lavage fluid was made by aerating the lactated Ringer＇s solution with 100% 02 at 1 L·min^-1 flow rate for 30 seconds. The tidal aliquot of lavage was 700 ml which was kept in the lung for 50 seconds and then drained. Each lung was lavaged with hyperoxygenated and plain lactated Ringer＇s solution 10 times each alternatively. While one lung was being lavaged the contralateral lung was mechanically ventilated with 100% O2 . SpO2 , MAP, HR, CVP and PrrCO2 were recorded immediately before lavage and at 10, 20, 30, 40, 50, 60, 70 and 80 seconds after the lung was filled with lavage fluid. SpO2 was significantly higher during lavage with hyperoxygenated fluid than with ordinary lactated Ringer＇s solution, but there was no significant difference in MAP, HR, CVP and PrrCO2. The PaO2 of the 3 patients breathing room air was 46-52 mm Hg before lung lavage and increased to （72.3 ± 2.1） nun Hg one week after left lung lavage and to （83.5 ± 4.8 ）mm Hg 3d after right lung lavage. During the lung lavage, hyperoxygenic significantly improve oxygen supply in patients with pulmonary alveolar proteinosis compared with lactated Ringer＇s solution.