支气管肺泡灌洗对系统性红斑狼疮合并弥漫性肺泡出血抢救价值的探讨

Value of bronchoalveolar lavage as a rescue complicated with diffuse alveolar hemorrhage measurement for systemic lupus erythenmtosus

目的探讨支气管肺泡灌洗在系统性红斑狼疮（SLE）合并弥漫性肺泡出血（DAH）抢救治疗中的应用价值。方法将21例SLE合并DAH患者随机分成两组，分别给予两种抢救措施，A组给予注射用甲泼尼松琥珀酸钠1000mg冲击治疗3d，B组给予注射用甲泼尼松琥珀酸钠1000mg冲击治疗3d辅助支气管肺泡灌洗1次。观察两组患者治疗前后二氧化碳分压（PaCO2）、氧分压、氧饱和度及呼吸困难程度勃氏评分（BS）的变化。结果治疗前后比较，除A组PaCO2改善其他指标差异无统计学意义（P〉0．05），B组的PaCO2以及两组的氧分压和氧饱和度均有显著性改善（均P〈0．05）。治疗后两组间比较PaCO2差异无统计学意义（P〉0．05），B组氧分压和氧饱和度改善程度显著高于A组（均P〈0．05）；经过治疗两组患者Bs显著下降（均P〈0．01），而且B组下降程度大于A组（P〈0．05）。结论支气管肺泡灌洗联合大剂量注射用甲泼尼松琥珀酸钠冲击治疗，可以显著改善SLE合并DAH患者急性期低氧血症及呼吸困难。

Objective To explore the value of bronchoalveolar lavage as an emergency treatment for systemic lupus erythematosus （SLE） patients with concurrent diffuse alveolar hemorrhage （DAH）. Methods A total of 21 SLE plus DAH patients were divided randomly into 2 groups. The patients in Group A received methylprednisolone 1000 mg/d for 3 days while those in Group B methylprednisolone 1000 mg/d for 3 days in combination with a bronehoalveolar lavage. Partial pressure of carbon dioxide （ PaCO2 ）, partial pressure of oxygen （PaO2）, oxygen saturation （SaO2 ） and Borg scale （BS） for quantitative evaluation of dyspnea were recorded before and after treatment. Results Except for PaCO2, all other parameters of blood gas analysis in all patients in Group A （P 〉 0. 05 ） were better after treatment than before （ all P 〈 0. 05 ）. After treatment, PaO2 and SaO2 in Group B were higher than those in Group A （ all P 〈 0. 05）, but PaCO2 was not markedly changed（P 〉 0. 05）. BS decreased significantly in both groups （both P 〈 0. 01 ）. And more decrease was observed in Group B as compared with Group A after treatment （P 〈 0. 05 ）. Conclusion Bronchoalveolar lavage plus a high-dose implosive therapy of methylprednisolone may alleviate hyoxemia and dyspnia in acute period of SLE complicated with DAH.