体外生命支持下重症肺泡蛋白沉积症肺灌洗安全性评价及术后管理

Safety evaluation and postoperative management of whole lung lavage in patients with severe pulmonary alveolar proteinosis assisted by extracorporeal life support

目的探讨重症肺泡蛋白沉积症(PAP)患者,在体外生命支持技术辅助下行同期双侧大容量全肺灌洗术(WLL)治疗的安全性,并总结术后监护管理经验。方法回顾性分析我院近年来7例重症PAP患者在体外生命支持技术(其中体外循环(CPB)4例、体外膜肺氧合(ECMO)3例)辅助下行同期双侧WLL术的术中、术后生命体征、呼吸氧合功能以及术后监护管理经验总结。结果术前存在严重低氧血症的重症PAP患者在CPB/ECMO支持下均顺利实施同期双侧WLL术,术中生命体征平稳,氧合满意;术后动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)、氧合指数均较术前明显升高(P<0.05);通过术后严格的监护管理,患者均顺利康复。结论重症PAP患者行同期双侧WLL术,体外生命支持技术能够维持满意的氧合,具有良好的安全性和有效性;术后加强监测管理能够为患者的恢复提供有力的保障。

Objective To investigate the safety of simultaneous bilateral massive whole lung lavage(WLL)in patients with severe pulmonary alveolar proteinosis(PAP)assisted by extracorporeal life support and to summarize the experience of postoperative monitoring management.Methods 7 patients with severe PAP in our hospital in recent years were done simultaneous bilateral massive whole lung lavage assisted by extracorporeal life support(cardiopulmonary bypass(CPB)in 4 cases and extracorporeal membrane oxygenation(ECMO)in 3 cases).Their vital signs,respiratory oxygenation function of the 7 patients at intraoperative and postoperative were retrospectively analyzed,and the experience of postoperative monitoring management was summarized.Results Severe PAP patients with severe hypoxemia preoperative were successfully done simultaneous bilateral massive whole lung lavage assisted by extracorporeal life support(CPB/ECMO).The vital signs and oxygenation intraoperative were stable.The arterial partial pressure of oxygen(PaO2),arterial oxygen saturation(SaO2)and oxygenation index at postoperative were significantly higher than those before operation(P<0.05).All patients recovered smoothly through strict monitoring management after operation.Conclusion Patients with severe PAP are treated with simultaneous bilateral WLL.The application of in vitro life support technique can maintain satisfactory oxygenation,which has good safety and effectiveness.Strengthening monitoring and management after operation can provide effective protection for patients recovery.