Ahrens P, Pabelick C, Schledt U, Behne M, Zielen S
Zentrum der Kinderheilkunde, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main.
Pneumologie. 1998 Mar;52(3):157-60.
Although bronchoalveolar lavage (BAL) is a useful tool even in childhood pulmonary diseases, only little is known about the problems attendant to its use. Hence, we investigated from a total of 212 rigid bronchoscopy procedures 22 patients of 1-10 years of age. General inhalation anaesthesia was performed and BAL was carried out using a paediatric standardised protocol. BAL volume was adjusted to body weight. Before BAL and 2, 7 and 20 minutes after BAL capillary blood gas, blood pressure, heart rate and SaO2 were measured. Continuously end-tidal PCO2 (ET (PCO2) measurement was done by using a catheter placed in the main stream bronchus. Mean ET PCO2 increased from 39.6 +/- 9.5 mmHg to 45.7 +/- 6.87 mmHg. Concomitantly mean capillary PCO2 increased from 46.68 +/- 10.7 mmHg to 50.1 +/- 10.47 mmHg. Correlation of ET PCO2 compared to cap PCO2 was good (r = 0.89). One patient showed desaturation up to 72% another patient hypercapnia up to 77 mmHg. We conclude that generally speaking BAL is a safe procedure, even in high-risk patients. Complications are minor and of little consequence to the patient. However, severe unforeseen events may occur. Therefore, bronchoscopy and bronchoalveolar lavage should not be performed without availability of an intensive-care unit.
尽管支气管肺泡灌洗（BAL）即使在儿童肺部疾病中也是一种有用的工具，但关于其使用所伴随的问题却知之甚少。因此，我们从总共212例硬质支气管镜检查手术中调查了22例1至10岁的患者。实施全身吸入麻醉，并采用儿科标准化方案进行BAL。BAL的量根据体重进行调整。在BAL前以及BAL后2分钟、7分钟和20分钟测量毛细血管血气、血压、心率和SaO₂。通过放置在主支气管中的导管持续测量呼气末PCO₂（ET（PCO₂））。平均ET PCO₂从39.6±9.5 mmHg升高至45.7±6.87 mmHg。同时，平均毛细血管PCO₂从46.68±10.7 mmHg升高至50.1±10.47 mmHg。ET PCO₂与毛细血管PCO₂的相关性良好（r = 0.89）。一名患者出现低氧血症至72%，另一名患者出现高碳酸血症至77 mmHg。我们得出结论，一般来说，BAL是一种安全的操作，即使在高危患者中也是如此。并发症轻微，对患者影响不大。然而，可能会发生严重的意外事件。因此，在没有重症监护病房的情况下不应进行支气管镜检查和支气管肺泡灌洗。
