全肺灌洗技术对肺泡蛋白沉着症患者肺功能及运动能力的影响研究

Effects of whole lavage on pulmomary function and exercise in patients with pulmonary alveolar proteinosis

目的比较全肺灌洗肺泡蛋白沉着症患者灌洗前与灌洗后1w肺功能指标的变化,探讨肺灌洗对患者短期内肺功能和运动能力的影响。方法对21例接受全肺灌洗患者采用自身对照方法,对灌洗前和灌洗后1w的临床状态、静态肺功能、心肺运动试验结果进行比较。结果 21例患者全肺灌洗后临床症状明显改善,灌洗后肺功能指标肺活量(VC)、用力肺活量(FVC)、第1秒用力呼气容积(FEV_1)、肺总量(TLC)、肺一氧化碳弥散量(TLCO)较灌洗前明显增高(P<0.05),其余观察指标灌洗前、后比较差异均无统计学意义(P>0.05)。峰值摄氧量从灌洗前的(2 280.6±251.4)mL/min上升到灌洗后的(2 624.3±316.8)mL/min,峰值摄氧量占预计值百分比从(79.1±14.5)%上升到(93.0±15.1)%,峰值公斤摄氧量从(28.5±3.8)mL/min上升到(35.7±4.2)mL/min,二氧化碳通气当量最低值从(29.4±2.9)上升至(25.9±3.5),灌洗后峰值摄氧量、峰值摄氧量占预计值百分比、峰值公斤摄氧量均高于灌洗前,差异均有统计学意义(P<0.05)。结论全肺灌洗从治疗后短期观察,可明显改善肺泡蛋白沉着症患者的通气功能及弥散功能,同时显著提高运动状态时的摄氧能力和通气效率,从而提高运动能力。

Objective To compare the changes of pulmonary function indexes after one week of the lung lavage and to investigate the effects of Massive whole lung lavage on the pulmonary function and exercise capacity in patients with pulmonary alveolar proteinosis in a short time.Methods 21 patients with lung lavage were compared with self control test method,and the results were compared of the clinical condition,static pulmonary function and cardiopulmonary exercise test before and after 1week.Results The patients with pulmonary alveolar proteinosis showed significantly changes in clinical symptoms and increased lung function indexes after lavage（P 0.05）,for example：vital capacity（VC）,forced vital capacity（FVC）forced expiratory volume in 1second（FEV_1）,total lung capacity（TLC）,carbon monoxide diffusing capacity（TLCO）.The rest were showed no significant differene（P 0.05）.At one week after lavage peak oxygen uptake increased from（2 280.6±251.4）mL/min to（2 624.3±316.8）mL/min,and percent predicted peak VO_2 increased from（79.1±14.5）% up to（93.0±15.1）%,peak VO_2/kg increased from（28.5±3.8）mL·min·kg to（35.7±4.2）mL·min·kg,ventilatory equivalent for carbon dioxide decreased from（29.4±2.9）up to（25.9±3.5）,the difference was statistically significant（P 0.05）.Conclusion The ventilation function and diffusion function in patients with pulmonary alveolar proteinosis can be improved by Massive whole lung lavage.Massive whole lung lavage can remarkably improve the oxygen uptake and ventilatory efficiency in patients with pulmonary alveolar proteinosis during exercise,thereby improving the exercise capacity of these patients.