双侧全肺灌洗对血流动力学和呼吸功能的影响

目的探讨肺泡蛋白沉积症(PAP)患者行大容量双侧全肺灌洗过程中血流动力学和呼吸功能的变化。方法对14例行全肺灌洗术的PAP患者临床资料进行回顾性分析。结果每次灌洗液注入肺时引起血流动力学和呼吸功能抑制,表现为中心静脉压(CVP)、胸液成分(TFC)、气道峰压(Peak)、气道平台压(Plat)、气道阻力升高,HR、有创血压(MAP)、每搏输出量(SV)、潮气量(VT)、肺顺应性降低(P<0.05或P<0.01),灌洗液吸出后改善。随着灌洗次数增加,血流动力学和呼吸功能抑制更明显,表现为MAP、CO、SV、心肌加速指数(ACI)、SpO2、呼气末二氧化碳(PetCO2)、体温、肺顺应性降低,CVP、TFC、Peak、气道阻力增加(P<0.05或P<0.01),恢复双肺通气后改善。两侧肺灌洗结束后表现为代谢性酸中毒,pH、BE、HCO3、TCO2降低(P<0.05或P<0.01),恢复双肺通气1h后改善。结论在每次肺灌洗液注入前后,血流动力学和呼吸功能均出现周期性波动。随着灌洗次数增加,全肺大容量肺灌洗使血流动力学和呼吸功能抑制。

Effects of Bilateral Whole Lung Lavage on Hemodynamics and Pulmonary Function

Objective To observe the changes in hemodynamics and pulmonary function in patients with pulmonary alveolar proteinosis（PAP） during whole lung lavage.Methods A retrospective analysis was conducted using data of 14 patients who had undergone whole lung lavage.Results Hemodynamics and respiratory function were inhibited when lavage fluid was instilled into the lungs,displaying increase in CVP,TFC,Peak,Plat and airway resistance and decrease in HR,MAP,SV,VT and pulmonary compliance.The inhibition was improved after fluid was sucked out.Hemodynamics and respiratory function were obviously inhibited in the fifth and tenth lavage,displaying increase in CVP,TFC,Peak and airway resistance and decrease in MAP,CO,SV,ACI,SpO2,PetCO2,body temperature and pulmonary compliance（P0.05 or P0.01）.The inhibition was improved after resuming two-lung ventilation.Metabolic acidosis was caused by decrease in pH,BE,HCO3 and TCO2 after whole lung lavage and was improved 1 hour after two-lung ventilation（P0.05 or P0.01）.Conclusion Hemodynamics and respiratory function fluctuate periodically before and after instilling fluid into lungs.With the increase in lavage times,whole lung lavage causes hemodynamics and respiratory function inhibition in PAP patients.