大容量全肺灌洗治疗尘肺病的效果评价

Evaluating the effect of large volume whole lung lavage on pneumoconiosis

目的探讨应用大容量全肺灌洗(wholelung lavage,WLL)治疗尘肺病的效果。方法对本院2014年9月—2019年10月进行WLL治疗的60例120例次患者,就其呼吸道症状、并发症、血气分析、肺功能等进行分析。结果①术后当天,立即感觉肺灌洗侧通气轻松率为100%,术后1 d,咳嗽、咳痰增加,而胸闷、呼吸困难等症状稍微好转,与术前比较差异无统计学意义(P>0.05);术后10 d,咳嗽、咳痰、胸闷、呼吸困难等呼吸道症状总有效率分别为95.00%、93.33%、96.67%、91.67%,与术前比较差异具有统计学意义(P<0.05);②出现并发症7例次(5.83%),其中低氧血症、低钾血症、肺部感染各1例次、咽部不适4例次;③血气分析:术后1 d,酸碱度(pH)、二氧化碳分压(PaCO2)、血氧分压(PaO2)、血氧含量(ctO2)、血氧饱和度(SaO2)等指标均有不同程度下降,与术前比较差异无统计学意义(P>0.05),术后10 d,PaO2、ctO2、SaO2明显增高,与术前比较差异具有统计学意义(P<0.05),而pH、PaCO2无改变(P>0.05);④肺功能:术后10 d无改变(P>0.05)。结论WLL对改善尘肺患者呼吸道症状及提高PaO2、ctO2、SaO 2指标有明显作用,对治疗尘肺病有一定疗效,值得推广。

Objective To explore the clinical efficacy of large volume whole lung lavage(WLL)in the treatment of pneumoconiosis.Methods Sixty patients received 120 times of large volume WLL from September 2014 to October 2019 in our hospital and the patients’respiratory symptoms,complications,blood gas analysis and lung function were analyzed.Results①On the day after the end of operation,100% patients had feeling of ventilatory relaxation at the side of lung lavage.On the first day after surgery,cough and sputum increased,while chest tightness and dyspnea symptoms improved slightly,there was no statistically significant difference by comparing with the preoperative ones(P>0.05).Ten days after operation,the total effective rates of respiratory symptoms such as cough,sputum,chest tightness and dyspnea were 95.00%,93.33%,96.67% and 91.67%,respectively,there were statistically significant differences by comparing with the preoperative ones(P<0.05).②Seven cases suffered complications(5.83%),including 1 case of hypoxemia,one case of hypokalemia,one case of pulmonary infection,and 4 cases of throat discomfort.③Blood gas analysis:on the first day after operation,the indicators of pH,carbon dioxide partial pressure(PaCO2),blood oxygen partial pressure(PaO2),blood oxygen content(ctO 2),blood oxygen saturation(SaO 2)decreased at various degrees,and there were no statistically significant differences by comparing with the preoperative ones(P>0.05).Ten days after surgery,the PaO2,ctO2 and SaO2 were significantly increased,and the differences were statistically significant by comparing with the preoperative ones(P<0.05),while there were no changes in pH and PaCO2(P>0.05).④Lung function:there was no change 10 days after operation(P>0.05).Conclusion WLL has a significant effect on improving respiratory symptoms in patients with pneumoconiosis and increasing the patients’PaO2,ctO2 and SaO2 indexes.It has certain efficacy in the treatment of pneumoconiosis,which is worth popularizing.