双肺同期大容量肺灌洗术治疗尘肺病肺功能评价

Evaluation of pulmonary function in patients with pneumoconiosis after simultaneous large-volume lavage in both lungs

目的通过比较双肺同期大容量肺灌洗尘肺患者灌洗前与灌洗后1周肺功能指标的变化,分析双肺同期大容量肺灌洗术对尘肺病患者肺功能的影响。方法选取2017年10月—2018年5月在中国煤矿工人北戴河疗养院收治的尘肺病患者进行双肺同期大容量肺灌洗100例。按照《大容量全肺灌洗术医疗护理常规及操作规程》对100名患者进行双肺同期大容量肺灌洗,在灌洗术前和灌洗术后1周检测患者肺功能各项指标,比较肺功能指标肺活量(VC)、用力肺活量(FVC)、肺总量(TLC)、1秒率(FEV1%/VC)、最高呼气流量(PEF)、呼吸后期瞬间流速(MEF 75%)、呼吸中期瞬间流速(MEF 50%)、呼吸中断流速(MEF 25%)、最大通气量(MVV)、残总比(RV/TLC)和弥散功能(DLCO)的变化。结果共纳入尘肺病患者100名,均为男性,尘肺Ⅰ期41例,尘肺Ⅱ期29例,尘肺Ⅲ期30例。平均年龄(49.07±6.65)岁,平均身高(170.62±4.94)cm,平均体重(70.23±10.05)kg,平均接尘年限(23.33±4.26)年,年龄、身高、体重及接尘工龄在不同组之间比较,差异均无统计学意义(均P>0.05);治疗前和治疗后7周肺功能VC、FVC、TCL、FEV1.0%、PEF呼气流速峰值、MEF25%、MEF50%、MEF75%、MVV、RV/TLC和DLCO指标,除MVV外,其余治疗前后比较差异均无统计学意义(均P>0.05);大容量双肺灌洗后1周,VC、TLC、RV/TLC各期别变化比较差异均无统计学意义(均P>0.05);大容量双肺灌洗后1周和DLCO各期别变化比较差异无统计学意义(P>0.05);大容量双肺灌洗后1周,PEF、MEF25%和MEF75%各期别变化比较差异均无统计学意义(均P>0.05);MEF50%各期别变化比较差异有统计学意义(P<0.05)。结论经过规范的双肺同期大容量肺灌洗及术后护理,尘肺病患者术后1周肺功能恢复较好,安全有效。

[Objective]To compare the changes of lung function indexes in patients with pneumoconiosis before and after simultaneous large-volume lavage in both lungs,analyze the effect of simultaneous large-volume lung lavage in both lungs on lung function of patients with pneumoconiosis.[Methods]100 pneumoconiosis patients received the simultaneous large-volume lavage in both lungs were collected from the Beidaihe Sanatorium for Chinese Coal Miners from October 2017 to May 2018.According to the Routine nursing and operational procedures for large volume whole lung lavage,100 patients were given the simultaneous large-volume lavage in both lungs,and the lung function indexes were tested before and one week after the treatment.The lung function indexes of vital capacity(VC),forced vital capacity(FVC),total lung volume(TLC),one second rate(FEV1%/VC),maximum expiratory flow(PEF),instantaneous flow rate of late respiratory phase(MEF 75%),instantaneous flow rate of mid respiratory phase(MEF 50%),interruptive flow rate(MEF 25%),maximum ventilation volume(MVV),residual to total ratio(RV/TLC)and diffusion function(DLCO)were compared.[Results]Totally 100 patients with pneumoconiosis were included,all were male.There were 41 cases of stageⅠpneumoconiosis,29 cases of stageⅡand 30 cases of stageⅢ.The average age was(49.07±6.65)years old,the average height was(170.62±4.94)cm,the average weight was(70.23±10.05)kg,and the average dust exposure time was(23.33±4.26)years.The differences in age,height,weight and dust exposure time were not statistically significant among different groups(all P>0.05).The differences in lung function indexes(VC,FVC,TCL,FEV1.0%,PEF,MEF25%,MEF50%,MEF75%,RV/TLC and DLCO),except MVV,were not statistically significant between before and seven weeks after the treatment(all P>0.05).One week after large-volume lung lavage,the differences in VC,TLC and RV/TLC were not statistically significant among different stages(all P>0.05).One week after large-volume lung lavage,the difference in DLCO was not statistically significant among different stages(P>0.05).One week after large-volume lung lavage,the differences in PEF,MEF25%and MEF75%were not statistically significant among different stages(all P>0.05),and there was statistically significant difference in MEF50%among different stages(P<0.05).[Conclusion]With the normative simultaneous large-volume lavage in both lungs and postoperative care,the lung function of pneumoconiosis patients recover well one week after operation,and the treatment is safe and effective.