Ramírez-Rivera J
Ambulatory Care Service, San Juan Veterans Affairs Medical Center, Puerto Rico 00936.
P R Health Sci J. 1992 Apr;11(1):27-32.
Bronchoalveolar lavage was originally developed as a method for the diagnosis and treatment of pulmonary alveolar proteinosis. The first technique devised, "segmental flooding", was cumbersome but effective. Samples obtained provided information about the alveolar cellular response and alveolar protein dynamics. Most importantly, "segmental flooding" showed that living lung parenchyma was not damaged by repeated irrigation with isotonic saline as some had proposed. The therapeutic success and limitations of this first method of bronchoalveolar irrigation provided the intellectual stimulus which lead to the development of therapeutic whole-lung lavage. Serial whole-lung lavages, coupled with well-timed lung biopsies, offered the first opportunity to demonstrate in man the alveolar cellular response in a disease process, the dynamics of the production and dissipation of pulmonary lipids and the functioning of the surfactant system. The new and complex studies of the lungs' cellular reactions and metabolism may be better understood in the historical context of the first observations made possible by the development of bronchoalveolar lavage.
支气管肺泡灌洗最初是作为一种诊断和治疗肺泡蛋白沉积症的方法而开发的。最初设计的“分段灌洗”技术虽然繁琐但有效。所获得的样本提供了有关肺泡细胞反应和肺泡蛋白动态的信息。最重要的是，“分段灌洗”表明，正如一些人所提出的那样，等渗盐水反复冲洗不会损害活的肺实质。这种第一种支气管肺泡灌洗方法的治疗成功与局限性提供了智力上的刺激，从而导致了治疗性全肺灌洗的发展。连续全肺灌洗，再加上适时的肺活检，首次提供了在人体中展示疾病过程中的肺泡细胞反应、肺脂质产生和消散的动态以及表面活性剂系统功能的机会。在支气管肺泡灌洗发展所带来的首次观察的历史背景下，可能会更好地理解对肺细胞反应和代谢的新的复杂研究。
