CAJ | 학술논문

目的观察和评价间歇加压通气、肾上腺素和加压灌洗在大容量全肺灌洗(WLL)中对残留液体吸收、改善血氧饱和度的影响.方法以150例WLL患者为观察对象,随机分为加压通气组(28例)、肾上腺素组(31例)、加压通气+肾上腺素组(29例)、加压输液袋组(30例)和对照组(32例),进行两肺分期WLL,比较各组患者的血氧饱和度(SpO2)、X线胸片表现、临床症状、肺功能等.结果各组间各项临床症状改变的差异无统计学意义(P＞0.05),与灌洗前比较,肾上腺素组肺活量(FVC)、25％肺活量流速(FEF25％)分别升高6.3％和10.9％,差异有统计学意义(P＜0.05)；与灌洗前比较,对照组FVC降低5.7％、第1秒用力呼气量(FEV10)和FEF25％分别升高10.9％和12.0％,差异有统计学意义(P＜0.05).其余各组间指标灌洗前后的差异均无统计学意义(P＞0.05).灌洗术中、术后,加压通气组、加压通气+肾上腺素组和对照组的低氧血症发生率分别为0、0和12.5％(8/64),差异有统计学意义(P＜0.01).各组的灌洗液总量和肺部残留液量的差异无统计学意义(P＞0.05).加压通气+肾上腺素组灌洗后3h胸片两侧光密度之差值最低为0.152±0.053,加压通气组为0.194±0.074,加压输液袋组为0.197±0.054,肾上腺素组为0.214±0.054,对照组为0.241 ±0.109,除肾上腺素组外,其余各组与对照组的差异均有统计学意义(P＜0.05).结论加压通气、肾上腺素和灌洗液加压联合用于WLL,有利于肺部残留液体的转运吸收,降低低氧血症的发生.
목적 관찰화평개간헐가압통기、신상선소화가압관세재대용량전폐관세(WLL)중대잔류액체흡수、개선혈양포화도적영향.방법 이150례WLL환자위관찰대상,수궤분위가압통기조(28례)、신상선소조(31례)、가압통기+신상선소조(29례)、가압수액대조(30례)화대조조(32례),진행량폐분기WLL,비교각조환자적혈양포화도(SpO2)、X선흉편표현、림상증상、폐공능등.결과 각조간각항림상증상개변적차이무통계학의의(P＞0.05),여관세전비교,신상선소조폐활량(FVC)、25％폐활량류속(FEF25％)분별승고6.3％화10.9％,차이유통계학의의(P＜0.05)；여관세전비교,대조조FVC강저5.7％、제1초용력호기량(FEV10)화FEF25％분별승고10.9％화12.0％,차이유통계학의의(P＜0.05).기여각조간지표관세전후적차이균무통계학의의(P＞0.05).관세술중、술후,가압통기조、가압통기+신상선소조화대조조적저양혈증발생솔분별위0、0화12.5％(8/64),차이유통계학의의(P＜0.01).각조적관세액총량화폐부잔류액량적차이무통계학의의(P＞0.05).가압통기+신상선소조관세후3h흉편량측광밀도지차치최저위0.152±0.053,가압통기조위0.194±0.074,가압수액대조위0.197±0.054,신상선소조위0.214±0.054,대조조위0.241 ±0.109,제신상선소조외,기여각조여대조조적차이균유통계학의의(P＜0.05).결론 가압통기、신상선소화관세액가압연합용우WLL,유리우폐부잔류액체적전운흡수,강저저양혈증적발생.
Objective To observe and evaluate the performances of intermittent positive pressure ventilation,beta-2 adrenergic receptor agonist,and pressure lavage in promoting residual fluid absorption and improving blood oxygen saturation during massive whole lung lavage (WLL).Methods A total of 155 patients were randomly divided into pressure ventilation (PV) group (n=28),adrenaline (Ad) group (n=31),PV plus Ad group (n=29),pressure infusion bag (PIB) group (n=30),and control group (n=32).The patients underwent staged MWLL of bilateral lungs.The blood oxygen saturation (SpO2) of arterial blood of finger,chest X-ray findings,clinical symptoms,and lung functions were observed before and after MWLL.Results There were no significant differences in change in clinical symptoms among the five groups after MWLL (P＞0.05).The Ad group showed 6.3％ increase in forced vital capacity (FVC) and 10.9％ increase in forced expiratory flow at 25％ of vital capacity (FEF25％) after MWLL (P＜0.05).The control group showed 5.7％ decrease in FVC,10.9％increase in forced expiratory volume in one second (FEV 10),and 12.0％ increase in FEF25％after MWLL (P＜0.05).No significant difference was found in other groups (P＞0.05).During and after MWLL,the incidence rates of hypoxemia in PV group,PV plus Ad group,and control group were 0,0,and 12.5％ (8/64),respectively (P＜0.01).There were no significant differences in total amount of lavage fluid and amount of residual fluid in the lung among all groups (P＞0.05).The smallest difference between the optical densities of the two lung fields on chest x-ray at 3 h after WLL was 0.152±0.053 in the PV plus Ad group,compared to 0.194±0.074 in the PV group,0.197±0.054 in the PIB group,0.214±0.054 in the Ad group,and 0.241±0.109 in the control group,with significant differences between the saline group and other groups except Ad group (P＜0.05).Conclusion Pressure ventilation,adrenaline,and pressure lavage can promote the transportation and absorption of residual fluid in the lung and decrease the incidence of hypoxemia during WLL.