Effros R M, Feng N H, Mason G, Sietsema K, Silverman P, Hukkanen J
Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee County Medical Center 53226.
J Appl Physiol (1985). 1990 Jan;68(1):275-81. doi: 10.1152/jappl.1990.68.1.275.
Uncertainty persists concerning the best method of estimating the volume and solute concentrations of the pulmonary epithelial lining fluid (ELF) recovered during bronchoalveolar lavage (BAL). In the present study, measurements were made of the BAL-to-plasma concentration ratios of a variety of solutes in an anesthetized rat model. One minute after an intravenous injection of labeled Na+ and urea, 5 ml of isotonic mannitol, saline, or glucose were injected into the trachea and an initial aliquot of the BAL was immediately removed. Initial BAL-to-plasma concentration ratios of urea, Na+, Cl-, Ca2+, and total protein were similar (ranging from 0.013 to 0.017) after BAL with mannitol, but albumin and transferrin ratios were approximately 60% lower and K+ ratios were five times greater. Lavage with saline yielded BAL-to-plasma urea concentration ratios similar to those obtained with mannitol lavage. The BAL-to-plasma specific activity of urea was about twice that of Na+, indicating that urea diffused into the ELF more rapidly than Na+ during the 70 s that elapsed between the time the radioactive urea and Na+ were injected into the circulation and the time when lavage was complete. Subsequent lavage samples also indicated that urea rapidly diffuses into the fluid-filled lungs. These experiments suggest that isotonic mannitol may be a useful solution for lavage, because it allows use of Na+ and perhaps Cl- as additional indicators of ELF dilution by BAL.(ABSTRACT TRUNCATED AT 250 WORDS)
关于估计支气管肺泡灌洗(BAL)过程中回收的肺上皮衬液(ELF)的体积和溶质浓度的最佳方法,仍存在不确定性。在本研究中,在麻醉大鼠模型中对多种溶质的BAL与血浆浓度比进行了测量。静脉注射标记的Na⁺和尿素1分钟后,将5ml等渗甘露醇、生理盐水或葡萄糖注入气管,并立即取出初始的BAL等分试样。用甘露醇进行BAL后,尿素、Na⁺、Cl⁻、Ca²⁺和总蛋白的初始BAL与血浆浓度比相似(范围为0.013至0.017),但白蛋白和转铁蛋白的比值约低60%,K⁺的比值则高五倍。用生理盐水灌洗得到的BAL与血浆尿素浓度比与甘露醇灌洗相似。尿素的BAL与血浆比活性约为Na⁺的两倍,这表明在放射性尿素和Na⁺注入循环至灌洗完成的70秒内,尿素比Na⁺更快地扩散到ELF中。随后的灌洗样本也表明尿素迅速扩散到充满液体的肺中。这些实验表明等渗甘露醇可能是一种有用的灌洗溶液,因为它允许使用Na⁺,也许还有Cl⁻作为BAL对ELF稀释的额外指标。(摘要截断于250字)