Center of Anesthesiology and Pain, Emergency General Hospital, Beijing, 100028, China.
Occupation Medicine Department, Emergency General Hospital, Beijing, 100028, China.
BMC Pulm Med. 2022 Apr 22;22(1):152. doi: 10.1186/s12890-022-01952-w.
Pneumoconiosis is a diffuse interstitial fibronodular lung disease, which is caused by the inhalation of crystalline silica. Whole lung lavage (WLL) is a therapeutic procedure used to treat pneumoconiosis. This study is to compare the effects of different negative pressure suction on lung injury in patients with pneumoconiosis undergoing WLL.
A prospective study was conducted with 24 consecutively pneumoconiosis patients who underwent WLL from March 2020 to July 2020 at Emergency General Hospital, China. The patients were divided into two groups: high negative suction pressure group (group H, n = 13, negative suction pressure of 300-400 mmHg) and low negative suction pressure group (group L, n = 11, negative suction pressure of 40-50 mmHg). The arterial blood gas, lung function, lavage data, oxidative stress, and inflammatory responses to access lung injury were monitored.
Compared with those of group H, the right and left lung residual were significantly increased in the group L (P = 0.04, P = 0.01). Potential of hydrogen (pH), arterial partial pressure of oxygen (PaO), arterial partial pressure of carbon dioxide (PaCO), lactic acid (LAC) and glucose (GLU) varied from point to point in time (P < 0.01, respectively). There was statistical difference in the trend of superoxide dismutase (SOD) and interleukin-10 (IL-10) over time between the two groups (P < 0.01, P = 0.02). In comparison with the group H, the levels of IL-10 (P = 0.01) and SOD (P < 0.01) in WLL fluid were significantly increased in the group L. There was no statistical difference in the trend of maximal volumtary ventilation (MVV), forced vital capacity (FVC), forced expiratory volume in one second (FEV1%), residual volume (RV), residual volume/total lung capacity (RV/TLC), carbon monoxide dispersion factor (DLCO%), forced expiratory volume in one second/ forced vital capacity (FEV1/FVC%) over time between the two groups (P > 0.05, respectively).
Low negative suction pressure has the potential benefit to reduce lung injury in patients with pneumoconiosis undergoing WLL, although it can lead to increased residual lavage fluid. Despite differing suction strategies, pulmonary function parameters including FEV1%, RV and DLCO% became worse than before WLL. Trial Registration Chinese Clinical Trial registration number ChiCTR2000031024, 21/03/2020.
尘肺是一种弥漫性间质纤维结节性肺疾病，由吸入结晶二氧化硅引起。全肺灌洗（WLL）是一种用于治疗尘肺的治疗程序。本研究旨在比较不同负压吸引对 WLL 治疗尘肺病患者肺损伤的影响。
2020 年 3 月至 7 月，在中国急诊总医院连续收治 24 例尘肺患者行 WLL，前瞻性研究。患者分为两组：高负压吸引组（组 H，n=13，负压吸引 300-400mmHg）和低负压吸引组（组 L，n=11，负压吸引 40-50mmHg）。监测动脉血气、肺功能、灌洗数据、氧化应激和炎症反应，以评估肺损伤。
与组 H 相比，组 L 的右肺和左肺残气量明显增加（P=0.04，P=0.01）。潜在氢（pH）、动脉血氧分压（PaO）、动脉血二氧化碳分压（PaCO）、乳酸（LAC）和葡萄糖（GLU）随时间呈点到点变化（P<0.01，分别）。两组间超氧化物歧化酶（SOD）和白细胞介素-10（IL-10）随时间的变化趋势存在统计学差异（P<0.01，P=0.02）。与组 H 相比，组 L 的 WLL 液中白细胞介素-10（P=0.01）和 SOD（P<0.01）水平明显升高。两组间最大肺活量（MVV）、用力肺活量（FVC）、一秒用力呼气容积百分比（FEV1%）、残气量（RV）、残气量/肺总量（RV/TLC）、一氧化碳弥散因子（DLCO%）、一秒用力呼气容积/用力肺活量（FEV1/FVC%）随时间的变化趋势无统计学差异（P>0.05，分别）。
低负压吸引可能有助于减轻尘肺患者 WLL 后的肺损伤，但会导致灌洗后残留液体增加。尽管采用了不同的抽吸策略，但 FEV1%、RV 和 DLCO%等肺功能参数在 WLL 后均较 WLL 前恶化。
中国临床试验注册中心 ChiCTR2000031024，2020 年 3 月 21 日。
