高氧溶液在肺灌洗治疗肺泡蛋白沉积症患者中改善氧供。

Hyperoxygenated solution for improved oxygen supply in patients undergoing lung lavage for pulmonary alveolar proteinosis.

机构信息

Department of Anesthesiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, Chin.

出版信息

Chin Med J (Engl). 2009 Aug 5;122(15):1780-3.

PMID:19781325

Abstract

BACKGROUND

At present, the most effective treatment for pulmonary alveolar proteinosis (PAP) remains whole-lung lavage in spite of the usually accompanying severe hypoxemia, which is expected to be prevented by hyperoxygenated solution improving oxygen supply during lavage. In this study, the efficacy and safety of the effect of hyperoxygenated solution were evaluated.

METHODS

Five patients underwent whole-lung lavage over a 28-month period. Each lung was lavaged with hyperoxygenated (HO) and normal saline solution (plain lactated Ringer's solution, NO) randomly and alternatively until the reclaimed fluid was clear. Random number was generated by computer before every cycle of lavage. If the number was odd, the patient was assigned to receive a lavage cycle with hyperoxygenated solution (HO group, n = 109); if the number was even, normal saline solution was used (NO group, n = 115). Data of saturation of peripheral oxygen (SPO(2)), mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR) and end-tidal carbon dioxide tension (P(ET)CO(2)) were taken down at 0, 30, 60, 90, 120, 150, 180, 210 and 240 seconds from the beginning of the instillation of solution, and frequency and volume of unilateral lung lavage were also recorded. Time interval between the left and the right lung lavage was 1 week.

RESULTS

No patient was withdrawn from the study due to low SPO(2) or leakage. Oxygen pressure was (730.21 +/- 7.43) mmHg in the hyperoxygenated solution against (175.73 +/- 5.92) mmHg in the normal saline solution (P < 0.01). Compared with baseline, SPO(2) increased significantly as the instillation of solution began (P < 0.01), leveled for about 30 seconds (P > 0.05), and then decreased significantly to the lowest at the time of drainage (compared with 120 seconds or peak, P < 0.01). SPO2 was higher in HO group than in NO group (P < 0.01). There were no significant differences in MAP, HR, CVP and P(ET)CO(2) between HO group and NO group (P > 0.05) and also among different time points (P > 0.05).

CONCLUSION

During the lung lavage for pulmonary alveolar proteinosis, hyperoxygenated solution could significantly improve oxygen supply in comparison with normal saline solution without obvious side effects.

摘要

背景

目前，全肺灌洗仍然是治疗肺泡蛋白沉积症（PAP）最有效的方法，尽管通常伴有严重的低氧血症，但高氧溶液有望通过在灌洗过程中改善氧供来预防。在这项研究中，评估了高氧溶液的效果的疗效和安全性。

方法

5 名患者在 28 个月期间接受了全肺灌洗。每个肺随机交替使用高氧（HO）和生理盐水溶液（普通乳酸林格氏液，NO）进行灌洗，直到回收的液体变清。在每次灌洗周期之前，通过计算机生成随机数。如果数字为奇数，则将患者分配到接受高氧溶液灌洗周期（HO 组，n = 109）；如果数字为偶数，则使用生理盐水溶液（NO 组，n = 115）。在溶液开始输注后的 0、30、60、90、120、150、180、210 和 240 秒时记录外周血氧饱和度（SPO2）、平均动脉压（MAP）、中心静脉压（CVP）、心率（HR）和呼气末二氧化碳分压（P（ET）CO2）的数据，并记录单侧肺灌洗的频率和体积。左肺和右肺灌洗之间的时间间隔为 1 周。

结果

没有患者因低 SPO2 或渗漏而退出研究。高氧溶液中的氧压为（730.21 ± 7.43）mmHg，生理盐水溶液中的氧压为（175.73 ± 5.92）mmHg（P < 0.01）。与基线相比，随着溶液的输注开始，SPO2 显著增加（P < 0.01），大约 30 秒后达到平衡（P > 0.05），然后在引流时显著下降至最低（与 120 秒或峰值相比，P < 0.01）。HO 组的 SPO2 高于 NO 组（P < 0.01）。HO 组和 NO 组之间的 MAP、HR、CVP 和 P（ET）CO2 无显着差异（P > 0.05），各时间点也无显着差异（P > 0.05）。