在存在限制性或阻塞性肺病的情况下，支气管肺泡灌洗术（BAL）的功能意义。

Pedreira Wilson Leite, de Souza Rogério, Fiks Iara Nely, Salge João Marcos, de Carvalho Carlos Roberto Ribeiro

Pulmonary Division, University of São Paulo Medical School, Rua Bagé 163 apto 182, São Paulo 04012-140, Brazil.

Respir Med. 2007 Jun;101(6):1344-9. doi: 10.1016/j.rmed.2006.10.003. Epub 2006 Nov 21.

Most of the complications associated to bronchoscopy are related to changes of the respiratory function during or after its performance. Prevention of complications should be achieved by understanding the effects of bronchoscopic procedures and their relation to the pulmonary function deterioration. Previous studies regarding the functional impairment caused by bronchoalveolar lavage (BAL) were mostly limited by the presence of interferent factors such as sedative drugs. Furthermore, it is not clear whether or not patients with different ventilatory disturbances present the same functional response to bronchoscopy and BAL. The aim of this study was to determine the additional effects of BAL over the respiratory function deterioration related to bronchoscopy in patients with different respiratory function profiles (normal, restrictive and obstructive). Forty patients submitted to bronchoscopy without premedication were divided into four groups: group I-normal pulmonary function submitted to basic bronchoscopy; group II-bronchoscopy in combination with BAL, subdivided according to pulmonary function: group IIa (normal function), group IIb (restrictive ventilatory disturbances) and group IIc (obstructive ventilatory disturbances). Spirometry was made before and after the bronchoscopic procedure. Baseline hemoglobin saturation was compared to the lowest level during the procedure. Functional worsening caused by the procedure was observed with a decrease in forced vital capacity (FVC), forced expiratory volume in the first second (FEV(1)) and Hemoglobin saturation in all groups. Comparison between groups showed no significant difference regarding the changes in FVC (P=0.8324), FEV(1) (P=0.6952) and hemoglobin saturation (P=0.5044). We conclude that standardized BAL, like the one used in our study, does not result in an increased risk for ventilatory impairment compared to bronchoscopy itself, independently of the presence of previous respiratory disease.

大多数与支气管镜检查相关的并发症都与检查过程中或检查后呼吸功能的变化有关。预防并发症应通过了解支气管镜检查操作的影响及其与肺功能恶化的关系来实现。以往关于支气管肺泡灌洗（BAL）所致功能损害的研究大多受到诸如镇静药物等干扰因素的限制。此外，不同通气障碍的患者对支气管镜检查和BAL是否呈现相同的功能反应尚不清楚。本研究的目的是确定在不同呼吸功能状况（正常、限制性和阻塞性）的患者中，BAL对与支气管镜检查相关的呼吸功能恶化的额外影响。40例未进行术前用药而接受支气管镜检查的患者被分为四组：第一组——肺功能正常接受基本支气管镜检查；第二组——支气管镜检查联合BAL，根据肺功能再细分：第二a组（功能正常）、第二b组（限制性通气障碍）和第二c组（阻塞性通气障碍）。在支气管镜检查前后进行肺活量测定。将基线血红蛋白饱和度与检查过程中的最低水平进行比较。观察到所有组在检查过程中用力肺活量（FVC）、第一秒用力呼气量（FEV₁）和血红蛋白饱和度下降，提示检查导致功能恶化。组间比较显示，FVC变化（P = 0.8324）、FEV₁变化（P = 0.6952）和血红蛋白饱和度变化（P = 0.5044）无显著差异。我们得出结论，与支气管镜检查本身相比，如我们研究中使用的标准化BAL不会增加通气功能受损的风险，与既往是否存在呼吸系统疾病无关。