矽肺动物模型全肺灌洗治疗的病理观察

通过对动物模型实验治疗的病理观察，评价全肺大容量灌洗治疗矽肺的效果，并优选灌洗液。对４０只家兔和１０只幼猪经ＳｉＯ２染尘处理后，各随机分为药物组、盐水组和对照组。４～５周后施行全肺大容量灌洗。治疗后３～５个月处死各组动物，进行病理双盲检查。经统计学秩和检验，兔与猪各组肺矽结节纤维化级别分布的差异有非常显著意义（Ｐ＜０．００５）。经卡方检验，各灌洗组的纤维化程度与对照组相比，差异亦有非常显著意义（Ｐ＜０．０１）。灌洗液中药与盐水比，Ｐ＜０．０５；盐水与西药比，Ｐ＜０．０５。兔和猪矽肺各灌洗组的效果明显优于对照组。灌洗液中药优于盐水，盐水又优于西药     

经皮肺活检及支气管肺泡灌洗对周围性肺疾病诊断的临床价值

目的：探讨经皮肺活检及支气管肺泡灌洗(BAL)对周围性肺疾病诊断的价值。方法：对以结节或块状阴影为主的52例病人行经皮肺活检；对以弥漫性周围性肺疾病为主的33例病人行BAL检查；对采用两种不同方法的检查结果进行阳性率分析。结果：52例经皮肺活检对肺周围性病变诊断敏感性为88％，特异性100％。33例行BAL检查对结核及恶性弥漫性肺周围性病变诊断敏感性为75％～80％，特异性100％。结论：BAL检查及经皮肺活检对肺周围块状阴影或弥漫性病变的确诊有很高价值。     

中性粒细胞在高浓度氧诱发急性肺损伤中的作用

目的:测定鼠支气管肺泡清洗液中细胞成分,阐明高浓度氧诱发急性肺损伤的发生机制。方法:20只雄性6周龄[(226±53.6)g]Wistar鼠被分为3组:(1)对照组(空气中饲养,n=6)。(2)实验组1(暴露在90%～95%氧气中24～48h,n=7)。(3)实验组2(暴露在90%～95%氧气中72h,n=7)。实验中动物可自由进食和水。结果:与对照组相比,实验组2的支气管肺泡清洗液中总细胞数减少[(3.81±0.35)×105/ml,(2.53±0.77)×105/ml];巨噬细胞数减少[(3.80±0.36)×105/ml,(2.09±0.59)×105/ml];而中性粒细胞计数明显增多[0,(43.56±42.63)×103/ml]。实验组2的动物都出现双侧胸水。结论:中性粒细胞动员并进入肺组织是高浓度氧诱发急性肺损伤的明显特征,损伤的发生与暴露时间有关。提示早期抑制中性粒细胞进入肺组织是治疗高浓度氧诱发急性肺损伤的重要途径。     

Effect of surfactant lavage in a rabbit model of meconium aspiration syndrome

Meconium aspiration syndrome (MAS) is a frequent cause of respiratory distress in neonates. Recent reports have suggested that surfactant dysfunction contributes to the pathophysiology of MAS and surfactant therapy improves oxygenation of infants with MAS. We evaluated the effect of bronchial lavage with surfactant solution in a rabbit model of meconium aspiration. All animals were given 5 mL/kg of a 20% slurry of human meconium into the endotracheal tube and mechanically ventilated. The animals were then divided into saline lavage (n = 5) or surfactant lavage (n = 5). Lavage was performed an hour after meconium instillation. After the lavage the total amount of meconium recovered was measured. Blood gas was monitored during the experiment. The amount of meconium recovered by saline lavage was 14%, and by surfactant lavage was 57%. The surfactant group had a significant improvement in gas exchange, whereas the saline group had no improvement. It was concluded that the lavage with surfactant solution effectively washed out meconium and improved gas exchange in rabbit model of MAS.     

EFFECTIVENESS OF CYTODIAGNOSIS WITH PANCREATIC DUCT LAVAGE FLUID FOR PANCREATIC DUCTAL CARCINOMA: NEW SAMPLING TECHNIQUE

Background: Pancreatic carcinoma is one of the most lethal cancers. Because pancreatic carcinoma is still very difficult to diagnose in its early stage, many of these patients will be considered unsuitable for surgery. If a cytological diagnosis is obtained at initial endoscopic retrograde cholangiopancreatography (ERCP), suitable treatment will be initiated without delay. Methods: To increase the number of exfoliated cells from the pancreatic duct, we devised a new technique, pancreatic duct lavage fluid (PDLF), following bronchoalveolar lavage fluid. The present paper reports the effectiveness of cytological examination using PDLF in the diagnosis of pancreatic carcinoma. We examined 18 pancreatic carcinoma cases. After the endoscopic retrograde pancreatography (ERP), PDLF was collected from a double‐lumen catheter inserted into the main pancreatic duct. Saline injected from the lumen for the injection, and PDLF was aspirated from the other lumen for the guidewire at the same time. The cytological examination was performed using PDLF. Results: Exfoliated cells were more frequently found in PDLF from all patients. In 15 cases (83%), cytological examination of PDLF revealed positive cytological results as the diagnosis of pancreatic carcinoma. Conclusion: Cytological examination using PDLF has a high sensitivity for detection of pancreatic carcinoma. The new examination, PDLF, is simple, safe and effective, so we expect PDLF to become widely popular.     

用纤支镜为支气管哮喘患者作肺灌洗的安全性观察

本文对12例支气管哮喘病人作了22例次支气管肺泡灌洗,其中3例次为重度哮喘发作;8例次为中度发作[1];11例次为缓解期.灌洗方法在一般肺灌洗的基础上经过改良后,12例病人无1例死亡.11例次哮喘发作患者,灌洗后临床症状皆有不同程度改善.11例次缓解期病人,灌洗后皆无不良反应.凡哮喘时间较长者,均能灌洗出较大量脓痰栓.     

慢性阻塞性肺疾病的肺生物学标记物研究进展

与慢性阻塞性肺疾病（COPD）有关的很多炎症细胞、介质,正逐渐为人们所熟知。本文讨论支气管活组织切片、痰液、支气管肺泡灌洗液、呼出气凝物等方面的有关生物标记在COPD研究中的进展。     

Reversible and irreversible airway inflammation and fibrosis in mice exposed to inhaled ovalbumin

Objective and design: We examined the reversibility of several changes in the lungs and airways of mice immediately after exposure to ovalbumin aerosol and after a period of recovery breathing clean air.Methods: Mice were exposed for 1, 2, 4, 6, 8, or 10 weeks, with recovery in clean air for 1–3 weeks.Results: Airway collagen content, exhaled NO, airway mucous cell hyperplasia, and lung lavage inflammatory cell content increased upon exposure to ovalbumin aerosol. All parameters except airway fibrosis decreased partially or completely to control values with recovery in clean air.Conclusions: Airway mucous cell hypertrophy and hyperplasia appear to be completely reversible after recovery in clean air, while exhaled NO and airway inflammation appear to be mostly reversible, except for persistence of lymphocytes in the lung lavage fluid. Airway fibrosis appears to be reversible when mice are exposed to ovalbumin aerosol for periods of up to 4 weeks of exposure, but becomes irreversible after 6 or more weeks of exposure.Received 30 June 2004; returned for revision 24 September 2004; accepted by J. S. Skotnicki 13 October 2004     

治疗老年重症呼吸衰竭42例临床分析

目的：探讨机械通气联合支气管肺泡灌洗（BAL）在治疗老年重症呼吸衰竭的作用。方法：选择常规治疗后病情无缓解的重症老年呼吸衰竭患者42例。建立人工气道行钡械通气治疗12～24h后，低氧血症纠正不理想，气道压力偏高，痰多者，应用加温至37℃生理盐水加庆大霉素、地塞米松及爱全乐经纤支镜行BAL，吸除呼吸道粘稠分泌物，每日一次，连续3—5天。结果：42例患者中，37例通气24h，经支气管肺泡灌洗后，气道压力下降，临床症状好转，缺氧及二氧化碳滞留得到改善，病原菌得到明确，成功脱机出院。结论：对老年重症呼吸衰竭在机械通气的基础上联合支气管肺泡灌洗是治疗呼吸衰竭安全有效的重要措施，值得临床应用。