Ramachandran Priya, Chaudhury Alisha, Devaraj Uma, Maheshwari K Uma, D'Souza George
Department of Pulmonary Medicine, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India.
Lung India. 2018 Jul-Aug;35(4):350-353. doi: 10.4103/lungindia.lungindia_344_17.
Lung ultrasound (LUS) has been proven to yield valuable information for lung and pleural pathology. It is well validated for assessing extravascular lung water. It can also be used to monitor stages of controlled lung de-aeration in whole lung lavage (WLL) which is the treatment for Pulmonary Alveolar Protienosis (PAP),characterized by abnormal surfactant in the alveoli affecting gas exchange .LUS can help decide the point of termination of lung flooding. A 55 year old lady with biopsy proven pulmonary alveolar proteinosis presented with respiratory failure. WLL was planned. LUS was used to study the stages of lung flooding as previously described for ARDS model.6 areas screened based on six areas that are normally examined like upper zone, mid zone and lower zone showed alveolar interstitial pattern. One lung ventilation (OLV) was done and isolation of lavage lung was confirmed which was seen as lung collapse (lung pulse) on LUS. Saline infusion resulted in increase in B lines followed by tissue like pattern with fluid bronchogram on LUS(alveolar flooding) in all the areas. During the lavage of the second lung, appearance of alveolar flooding pattern resulted in termination of saline infusion. The use of LUS in monitoring WLL reduced amount of saline used for lavage, pick up complications like pleural effusion and spillage.
肺部超声（LUS）已被证明可为肺部和胸膜病变提供有价值的信息。它在评估血管外肺水方面得到了充分验证。它还可用于监测全肺灌洗（WLL）中可控性肺去气的阶段，全肺灌洗是治疗肺泡蛋白沉积症（PAP）的方法，其特征是肺泡表面活性物质异常影响气体交换。LUS有助于确定肺灌洗终止点。一名55岁经活检证实为肺泡蛋白沉积症的女性患者出现呼吸衰竭。计划进行全肺灌洗。LUS用于研究如先前针对ARDS模型所描述的肺灌洗阶段。基于通常检查的六个区域（如上部区域、中部区域和下部区域）筛选的6个区域显示出肺泡间质模式。进行了单肺通气（OLV），并确认了灌洗肺的隔离，在LUS上表现为肺萎陷（肺搏动）。盐水注入导致B线增加，随后在所有区域的LUS上出现类似组织样模式并伴有液体支气管征（肺泡灌洗）。在第二个肺灌洗期间，肺泡灌洗模式的出现导致盐水注入终止。在监测全肺灌洗中使用LUS减少了灌洗所用盐水的量，发现了如胸腔积液和渗漏等并发症。
