摘要
目的探讨大容量全肺灌洗术(whole-lung lavage,WLL)疗效及安全性。方法对某院1991年3月至2018年8月进行的13 787人15 000例次WLL患者,就临床症状、肺功能、胸片、并发症等情况进行进行回顾性分析。结果 (1)WLL术后10 d,胸闷、胸痛、气短的好转率分别为99%、86%、88%,对45例患者观察3年疗效持续巩固。(2)清除粉尘量:每侧肺平均清除粉尘3 000～5 000 mg,其中游离SiO_2 70～200 mg;清除细胞总数3.2×10~8～1.23×10^(10)个,吞尘巨噬细胞占87%～95%。(3)远期疗效观察:45例3年随访情况表明,体力明显增加32例(71.7%),治疗前后体质量平均增加2.18 kg,感冒、上呼吸道感染次数减少91.1%。肺功能在小气道阻力、弥散功能方面有明显改善。60例远期疗效观察:WLL术后6～7年疗效持续巩固,肺功能无显著性差异。胸部X线片病变进展、明显进展率,治疗组为16.4%(5/30)明显低于对照组43.3%(13/30),P<0.01;稳定率治疗组为83.3%(25/30),高于对照组56.7%(17/30),P<0.05。(4)生活质量:灌洗组的生存质量综合评价优于非灌洗组,差异有高度统计学意义(P<0.01)。灌洗组在躯体感觉、生理功能和社会活动等维度的生存质量优于非灌洗组,差异有统计学意义(P<0.05);在心理功能和其他维度上,灌洗组与非灌洗组比较,差异无统计学意义(P>0.05),按同一年龄段、同一接尘年限、期别相同、接尘性质相同分层比较,灌洗组生存质量优于非灌洗组(P<0.05)。(5)并发症:随着WLL技术的不断成熟、规范操作,不良反应逐年下降,1994年前并发症发生率为48.1%,1995—2004年为8.4%,2005年后为1.24%,差异有高度统计学意义(P<0.01)。结论临床实践证明,WLL是治疗尘肺病有效方法之一,严格掌握适应证、规范操作可降低不良反应,确保WLL安全。
Objective To investigate the curative effect and safety of whole-lung lavage（WLL）.Methods 13 787 WLL patients admitted in a hospital for 15 000 times from March 1991 to August 2018 were analyzed retrospectively in aspects like clinical symptoms,lung function,chest radiography and complications.Results ①10 days after WLL operation,the improvement rates of chest distress,chest pain and short of breath were 99%,86% and 88%.After 3-year observation of 45 patiennts,the curative effect lasted and consolidated.②Dust removal amount：lung of each side removed dust of 3 000～5 000 mg,with 70～200 mg free SiO2.The total amount of cells removed were 3.2×108～1.23×1010,with pulmonary alveolar macrophage accounting for 87%～95%.③Long-term curative effect observation：in the 3-year follow-up study of 45 patients,the physical strength of 32 patients increased significant,accounting for 71.7%.After the treatment,their weight increased 2.18 kg on average and times of catching cold and upper respiratory infection decreased by 91.1%.Lung functions like small airway resistance and diffusion function improved significantly.Long-term curative effect observation of 60 patients：6 to 7 years after WLL operation,the curative effect lasted and consolidated with no significant difference in lung function.Disease progression,significant progressive rate of chest X-ray of the treatment group was 16.4%,significantly lower than that 43.3% of the control group and the difference showed statistical significance,P〈0.01.The stability rate of the treatment groups was 83.3%,higher than that 56.7% of the control group and the difference showed statistical significance,P〈0.05.④Life quality：the comprehensive life quality of the WLL group was better than that of the non-WLL group and the difference showed statistical significance（P〈0.01）.The life quality concerning physical feeling,physical function and social activities was better than that of the non-WLL group and the difference was of statistical significance（P〈0.05）.The WLL group showed no significant difference from the non-WLL group on aspects like mental functions（P〉0.05）.The life quality of WLL group was better than that of the non-WLL group（P〈0.05） concerning age,exposure period to dust,phase and nature of dust.⑤Complications：with the perfection of WLL technology,regularization of practices,side effect decreased year by year,with the occurrence rate of complication being 48.1% before 1994,8.4% from 1995 to 2004 and 1.24% after 2005 and the difference was of significant statistical significance（P〈0.01）.Conclusion It has been proven by clinical practice that WLL is one of the effective methods to treat pneumoconiosis.By grasping indications and regularizing practice,side effects can be reduced and safety of WLL be ensured.
出处
《中国疗养医学》
2018年第11期1124-1129,共6页
Chinese Journal of Convalescent Medicine
关键词
大容量肺灌洗
治疗
尘肺病
Whole-lung lavage；Treatment；Pneumoconiosis
