大容量全肺灌洗治疗尘肺病术中肺顺应性的变化

Changes of Lung Compliance of Pneumoconiosis Patients with Therapy of Whole Lung Lavage

目的探讨大容量全肺灌洗术中肺顺应性的变化。方法选择各期煤工尘肺及矽肺患者252例,其中合并慢性支气管炎(以下简称慢支)73例、无慢支的179例,采用规范的大容量全肺灌洗术进行治疗,监测术前、灌洗毕、第二肺灌洗前、停止麻醉前每侧肺的动态顺应性及灌洗毕肺顺应性恢复时间;观察肺顺应性与病变期别及合并症的关系。结果Ⅰ期、Ⅱ期、Ⅲ期术前肺顺应性分别为(38.3±8.2)、(36.8±7.0)、(39.1±10.3)ml/cmH2O,灌洗毕肺顺应性分别为(20.6±6.4)、(20.1±5.5)、(19.2±1.4)ml/cmH2O,较术前下降,差异有统计学意义(P<0.01)。灌洗侧肺恢复时,肺顺应性Ⅰ期(31.4±6.6)ml/cmH2O、Ⅲ期(26.2±1.4)ml/cmH2O,较术前下降,差异有统计学意义(P<0.01)。不同期别通气肺在肺灌洗术毕和灌洗侧肺恢复时,肺顺应性较术前下降,差异无统计学意义(P>0.05)。Ⅰ期尘肺合并慢支者,肺顺应性术前(36.6±7.7)ml/cmH2O、术毕(20.6±6.4)ml/cmH2O及灌洗肺恢复时(32.7±7.7)ml/cmH2O,比无合并症者肺顺应性术前(39.1±8.2)ml/cmH2O、术毕(22.6±5.7)ml/cmH2O及灌洗肺恢复时〔(34.9±5.8)ml/cmH2O〕均降低,差异有统计学意义(P<0.05);Ⅱ期、Ⅲ期尘肺有无合并慢支者肺顺应性比较,差异无统计学意义(P>0.05)。不同期别患者灌洗侧肺顺应性恢复时间Ⅰ期(78.4±20.1)min,Ⅱ期(108.0±25.2)min,Ⅲ期(110.2±27.6)min,随着期别的增加而延长,差异有统计学意义(P<0.05)。结论大容量全肺灌洗术可导致肺顺应性降低,Ⅱ期和Ⅲ期尘肺受影响更大;期别越高,灌洗侧肺顺应性恢复时间越长。

Objective To explore changes of the lung compliance with whole lung lavage （WLL）. Methods 252 coal worker＇s pneumoconiosis and silicosis patients of various stages, among which 73 cases complicated with chronic bronchitis and 179 cases not, were treated with standardized WLL. The dynamic compliances of each lung before and after WLL, before the second lavage and before quitting anaesthesia as well as the recovery time of lung comphance were monitored. Results The lung compliances of stage Ⅰ, Ⅱ and Ⅲ before WLL were（38.3±8.2）ml/cmH2O, （36.8±7.0）ml/cmH2O and（39.1±10.3）ml/cmH2O respectively, while those of after WLL reduced to（20.6± 6.4） ml/cmH2O, （20. 1 ±5.5） ml/cmH2O and （ 19.2 ± 1.4） ml/cmH2O respectively, the differences were significant （P〈0.01 ）. At the recovery of lavaged lateral lung, the lung compliance of stage Ⅰ was （31.4±6.6）ml/cmH2O, and that of stage Ⅲ was （26.2 ± 1.4）ml/cmH2O, the difference was significant（P〈0.01）. In different stages of the ventilated lung when WLL finished and the lavaged lung recovered, the lung compliance decreased, but the difference was not significant（P〉0.05）. In stage Ⅰ complicated with chronic bronchitis, the lung compliance of pre-WLL was （36.6±7.7） ml/cmH2O, that of after WLL was （20.6 ± 6.4）ml/cmH2O, and that of the recovered compliance was（32.7 ± 7.7） ml/cmH2O, while those of patients without complication were（39.1 ± 8.2） ml/ cmH2O, （22.6 ±5.7） ml/cmH2O and （ 34.9 ± 5.8） ml/cmH2O respectively, the differences were significant （P〈0.05）. As to the stage Ⅱ and Ⅲ, no matter complicated with chronic bronchitis or not, the differences of their compliances were not significant（P〉0.05）. The recovery time of lung compliance in stage I was （78.4 ±20. 1）min, in stage Ⅱ was （108.0 ± 25.2） min, and Conclusions WLL could decrease the lung compliance; greater. The recovery time of lung compliance in pneumoeoniosis stage. in stage Ⅲ was（110.2±27.6） min（P〈0.05）. especially in those of stage Ⅱ and Ⅲ the impact is lavaged lung prolongs with the progress of the pneumoconiosis stage.