CAJ | 학술논문

目的探讨重复全肺灌洗(RWLL)治疗矽肺的远期效果.方法选择在同一石材矿区作业的60例矽肺患者,根据年龄、矽肺期别、接尘工龄等按1∶1比例随机分为RWLL组与全肺灌洗(WLL)组,进行远期疗效和安全性对比观察,并对RWLL组二次右肺支气管肺泡灌洗回收液(BALF)进行细胞学和SiO2含量测定.结果治疗4年后,RWLL组咳嗽、气喘好转率分别为68.4％、75.0％,高于WLL组(52.4％、57.9％),但差异无统计学意义(P＞0.05).治疗6年后,RWLL组气喘好转率为70.0c％,明显高于WLL组(36.8％),差异有统计学意义(P＜0.05).RWLL组治疗6年后用力肺活量(FVC)与第1秒用力呼气量(FEV1.0)比治疗前逐渐下降,但差异无统计学意义(P＞0.05);治疗6年后WLL组,FVC与 FEV1.0比治疗前明显下降,差异有统计学意义(P＜0.05).治疗4、6年后,RWLL组X线胸片无变化率高于WLL组,进展与明显进展率低于WLL组,两组比较,差异均无统计学意义(P＞0.05).RWLL组第1次右肺BALF检查:细胞数为6.71×107～2.14×109/L,平均4.50×108/L;肺泡巨噬细胞(PAM)比率为0.873～0.980,平均0.954;SiO2含量18～104.7 mg,平均93.7 mg.第2次BALF检查:细胞数为5.71×106～1.30×109/L,平均为9.12×107/L;PAM比率0.710～0.926,平均0.870;SiO2含量6～90.2 mg,平均46.2 mg.RWLL组围手术期发生痰血,胸痛各1例,发生率6.7％.在随访1年中,RWLL组并发左侧气胸,肺部感染各1例;WLL组并发肺部感染1例.结论 RWLL治疗矽肺不仅合理而且安全,并有助于进一步提高WLL治疗矽肺的远期疗效.
목적 탐토중복전폐관세(RWLL)치료석폐적원기효과.방법 선택재동일석재광구작업적60례석폐환자,근거년령、석폐기별、접진공령등안1∶1비례수궤분위RWLL조여전폐관세(WLL)조,진행원기료효화안전성대비관찰,병대RWLL조이차우폐지기관폐포관세회수액(BALF)진행세포학화SiO2함량측정.결과 치료4년후,RWLL조해수、기천호전솔분별위68.4％、75.0％,고우WLL조(52.4％、57.9％),단차이무통계학의의(P＞0.05).치료6년후,RWLL조기천호전솔위70.0c％,명현고우WLL조(36.8％),차이유통계학의의(P＜0.05).RWLL조치료6년후용력폐활량(FVC)여제1초용력호기량(FEV1.0)비치료전축점하강,단차이무통계학의의(P＞0.05);치료6년후WLL조,FVC여 FEV1.0비치료전명현하강,차이유통계학의의(P＜0.05).치료4、6년후,RWLL조X선흉편무변화솔고우WLL조,진전여명현진전솔저우WLL조,량조비교,차이균무통계학의의(P＞0.05).RWLL조제1차우폐BALF검사:세포수위6.71×107～2.14×109/L,평균4.50×108/L;폐포거서세포(PAM)비솔위0.873～0.980,평균0.954;SiO2함량18～104.7 mg,평균93.7 mg.제2차BALF검사:세포수위5.71×106～1.30×109/L,평균위9.12×107/L;PAM비솔0.710～0.926,평균0.870;SiO2함량6～90.2 mg,평균46.2 mg.RWLL조위수술기발생담혈,흉통각1례,발생솔6.7％.재수방1년중,RWLL조병발좌측기흉,폐부감염각1례;WLL조병발폐부감염1례.결론 RWLL치료석폐불부합리이차안전,병유조우진일보제고WLL치료석폐적원기료효.
objective To preliminary study the long term therapeutic effects of repeat the whole lung lavage (RWLL) in the treatment of silicosis.Methods A total of 60 patients with silicosis in the same stone mine were randomly and equally divided into repeat the whole lung Lavage (RWLL) group and whole lung Lavage (WLL) group based on silicosis staging,age and working age of dust exposure.Comparative analysis was performed to evaluate the long-term therapeutic efficacy and safety of RWLL.The cell count and SiO2 content were measured in twice right lung bronchoalveolar lavage fluid(BALF) of the RWLL group.Results Four years after treatment,the cough and asthma improvement rates of the RWLL group were 68.4％ and 75.0％ higher than those (52.4％ and 57.9％) of the WLL group (P＞0.05).Six years after treatment,the asthma improvement rate (70.0％) of the RWLL group was significantly higher than that (36.8％) of the WLL group (P＜0.05).The RWLL group showed slight decrease in forced vital capacity (FVC) and forced expiratory volume in one second (FEV1.0) after treatment (P＞0.05),while the WLL group showed significant decrease in FVC and FEV1.0 in the six years after treatment (P＜0.05).Four and Six years after treatment,the RWLL group had higher no change rate and lower progression rate and significant progression rate than the WLL group in terms of chest Xray (P＞0.05).In the RWLL group,the first time the right lung BALF test showed a number of cells 6.71 ×107～2.14× 109/L,average 4.50×108/L,pulmonary alveoli macrophages (PAM) ratio of 0.873～0.980,average 0.954and SiO2 content of 18～104.7 mg.average 93.7 mg; the second test showed a number of cells 5.71×106～1.30×109/L,average 9.12× 107/L; PAM ratio 0.710～0.926,average 0.870 and SiO2 content of 6～90.2 mg,average 46.2 mg.The RWLL group happened hemoptysis 、chest pain one case in perioperative period,the incidence of 6.7％.The RWLL group complicated by left pneumothorax、pulmonary infection one case and the WLL group complicated by one case of lung cancer in a year of follow-up.Conclusion RWLL is reasonable and safe treatment which could help to further improve the long-term effects of WLL for silicosis.