机械通气下经支气管镜肺活检

Transbronchial Lung Biopsy During Mechanical Ventilation

目的评估机械通气患者进行经支气管镜肺活检(TBLB)的安全性和有效性。方法回顾性分析2001年1月至2007年9月在广州呼吸疾病研究所ICU做TBLB检查的19例机械通气患者的临床资料。结果19例患者中,男10例,女9例;平均年龄(57.94±15.00)岁。9例(47.4%)患者经TBLB确诊:肺部曲霉性肺炎4例(21.0%),肺癌2例(10.5%),放射性肺炎1例(5.3%),肺出血肾炎综合征1例(5.3%),肺结核1例(5.3%)。TBLB未能确诊10例:肺间质纤维化6例(31.6%),肺组织非特异性改变4例(21.0%)。10例(52.6%)患者根据TBLB结果改变治疗方案。TBLB的并发症包括:出血≥30mL4例(21.0%),低氧血症11例(57.9%),低血压5例(26.3%),心动过速1例(5.3%),无气胸及患者死亡。结论对机械通气患者进行TBLB是安全的,有一定的诊断价值,可以作为开胸肺活检之前的选择。

Objective To evaluate the safety and diagnostic yield of transbronchial lung biopsy （TBLB） performed in mechanically ventilated patients. Methods TBLB was performed in 19 mechanically ventilated patients form January 2001 to September 2007 in the ICU of Guangzhou Institute of Respiratory Diseases. The results of clinical data were retrospectively analyzed. Results A total of 19 patients were analyzed[9 female, 10 male,with a mean age of （57.94±15.00） years]. Specific diagnoses were made in 9 cases （47.4%） by TBLB. The diseases included pulmonary aspergillus pneumonia in 4 cases （21.0%）, lung cancer in 2 cases （ 10. 5% ） , radioactive pneumonia in 1 case（5.3% ） , Goodpasture＇ s syndrome in 1 case（5.3% ）,pulmonary tuberculosis in 1 case （5.3%）. Ten cases （52. 6% ） were not able to establish confirmed diagnoses including pulmonary interstitial fibrosis in 6 cases（ 31.6% ） and lung tissue nonspecific changes in 4 cases （21.0%）. The treatment was adjusted according to the results of TBLB in 10 patients （52.6%）. Complications associated with this procedure included episodes of bronchial hemorrhage of ≥ 30 mL in 4 cases （21.0%）, transient oxygen desaturation in 11 cases （57. 9% ）, hypotension in 5 cases （26. 3% ）, and transient tachycardia in 1 case （5.3%） without death and pneumothorax. Conclusions TBI,B can be performed safely and has a diagnostic value in mechanically ventilated patients. TBLB should be considered as a diagnostic procedure before open lung biopsy.