分段肺泡灌洗与全肺灌洗治疗肺泡蛋白沉着症患者效果的比较

Comparing the effect of segmental bronchoalveolar lavage and whole lung lavage in treatment of patients with pulmonary alveolar proteinosis

目的通过对分段肺泡灌洗和全肺灌洗治疗肺泡蛋白沉着症(pulmonary alveolar proteinosis,PAP)患者的疗效及安全性比较,以寻找PAP最有效的治疗方法。方法选取2002年1月～2012年3月昆明市第一人民医院呼吸二科住院的16例PAP患者,分为分段肺泡灌洗(segmental bronchoalveolar lavage,SBL)和全肺灌洗(wholelung lavage,WLL)治疗组。其中SBL治疗组7例,WLL治疗组9例。比较两组灌洗液量、灌洗液回收率、术中及术后并发症方面的差异,以及术后1个月两组在肺功能的一氧化碳弥散量(DLCO)、第一秒用力呼气容积(FEV1)、用力肺活量(FVC)、最大通气量(MVV)实测值占预计值百分比、氧分压(PaO2)、氧饱和度(SaO2)、Borg呼吸困难评分、6 min步行试验、胸部高分辨率CT(HRCT)上病灶吸收方面的差异。结果 WLL治疗组灌洗液入量、回收率明显高于SBL治疗组,差异有统计学意义(P<0.05)。术中两组均未出现并发症,且术后两组在出现并发症方面无差异(P>0.05)。术后1个月在改善患者肺功能(DLCO%、FEV1%、FVC%、MVV%)、PaO2、SaO2、Borg呼吸困难评分、6 min步行试验、胸部HRCT病灶吸收方面WLL治疗组均优于SBL组,差异均有统计学意义(P<0.05)。结论 WLL较SBL治疗PAP的疗效好,值得在临床推广。

Objective To search the effective treatment for PAP by comparing the curative effect and security of seg- mental bronchoalveolar lavage and whole lung lavage in treatment of patients with pulmonary alveolar proteinosis （PAP）. Methods 16 patients diagnosed with PAP were divided into segmental bronchoalveolar lavage （SBL） treatment group and whole lung lavage （WLL） treatment group from two department of respiratory medicine, the First People＇s Hospital of Kunming City from January 2002 to March 2012. And seven patients were enrolled in SBL treatment group, nine patients were enrolled in whole lung lavage treatment group. The difference of two groups on lavage fluid volume, lavage fluid recovery rate, intraoperative and postoperative complications, and on DLCO%, FEVI%, FVC%, MVV% predicted value in pulmonary function, PaO2, SaO2, borg dyspnea score, six-minute walk test, focus absorption on high resolution CT （HRCT） of chest after one month of post-treatment were compared. Results The lavage fluid vol- ume, lavage fluid recovery rate of WLL treatment group were significantly higher than that of SBL treatment group, the difference had statistical significance （P 〈 0.05）. Two groups all did not appear complications during operation, and the postoperative complications of WLL treatment group were lower than that of SBL treatment group, but the differ- ence had no statistical significance （P 〉 0.05）. WLL treatment group were superior to the SBL treatment group in im- proving DLCO%, FEV1%, FVC%, MVV% predicted value in pulmonary function, PaQ, SaO2, Borg dyspnea score, six minutes walking test, focus absorption on HRCT of chest after one month of post-treatment, the difference had statisti- cal significance （P 〈 0.05）. Conclusion The curative effect of WLL is better than that of SBL, so WLL is worthy popu- larized in clinical.