Spanevello A, Migliori G B, Satta A, Sharara A, Ballardini L, Ind P W, Neri M
Division of Pneumology, Fondazione Salvatore Maugeri, Clinica del Lavoro e della Riabilitazione, Care and Research Institute, Tradate, Italy.
Respir Med. 1998 Feb;92(2):191-7. doi: 10.1016/s0954-6111(98)90094-4.
The aims of this study were to (1) record the changes of (arterial oxygen partial pressure) PaO2, (arterial carbon dioxide partial pressure) PaCO2, (percentage saturation of haemoglobin with oxygen in arterial blood) SaO2 and alveolar-arterial (A-a) oxygen gradiant resulting from bronchoalveolar lavage (BAL) in asthmatic and normal subjects; (2) measure changes in forced expiratory volume in 1 s (FEV1), vital capacity forced (FVC) associated with BAL; and (3) assess possible predictive factors for the degree of hypoxaemia and impairment of spirometry resulting from BAL. Bronchoscopy and BAL (150 ml) were performed in 24 asthmatics and 15 healthy subjects. Serial arterial blood samples (radial artery) were obtained in all subjects: T1 and before T2 after local anaesthesia; T3 at end of bronchoscopy; T4 after BAL and 5 min, 15 min, 1 h, 2 h, 8 h and 24 h (T5-T10) after the procedure, FEV1 and FVC were measured immediately before and 5 min afer bronchoscopy. Baseline PaO2 was lower in asthmatics (10.2 +/- 0.8 kPa) than in healthy subjects (10.8 +/- 0.8). Both groups showed a significant decrease in PaO2, and a significant widening in (A-a) oxygen tension gradiant at T3-9, with respect to T1 (P < 0.05). PaO2 reached a significantly lower value in asthmatics (7.1 +/- 0.6 kPa) than in HS (7.7 +/- 0.5; P < 0.05). In asthmatics, FEV1, FVC and the ratio FEV1/FVC decreased significantly after BAL (P < 0.001). In healthy subjects, FEV1 and FVC decreased significantly (P < 0.001), whereas FEV1/FVC did not. The fall in FEV1 after BAL was significantly greater in asthmatics (32.4 +/- 10.0%) than in healthy subjects (17.7 +/- 4.6; P < 0.001). Severity of asthma, basline FEV1 or initial PaO2 did not predict the degree of hypoxaemia or the fall of FEV1. It is concluded that BAL causes more severe hypoxaemia and a greater decrease in FEV1 in asthmatics compared to healthy subjects, strongly supporting the recommendation of special caution and careful monitoring when BAL is undertaken in asthmatics.
(1)记录哮喘患者和正常受试者支气管肺泡灌洗（BAL）后动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、动脉血氧饱和度（SaO2）及肺泡-动脉血氧梯度（A-a）的变化；(2)测量BAL相关的第1秒用力呼气容积（FEV1）和用力肺活量（FVC）的变化；(3)评估BAL导致低氧血症程度和肺量计功能损害的可能预测因素。对24例哮喘患者和15例健康受试者进行了支气管镜检查及150ml的BAL。所有受试者均采集系列动脉血样本（桡动脉）：局部麻醉后T1及T2前；支气管镜检查结束时T3；BAL后及操作后5分钟、15分钟、1小时、2小时、8小时和24小时（T5-T10），在支气管镜检查前及检查后5分钟测量FEV1和FVC。哮喘患者的基线PaO2（10.2±0.8kPa）低于健康受试者（10.8±0.8）。两组在T3至T9时PaO2均显著下降，（A-a）氧分压梯度相对于T1显著增宽（P<0.05）。哮喘患者的PaO2显著低于健康受试者（7.1±0.6kPa比7.7±0.5；P<0.05）。在哮喘患者中，BAL后FEV1、FVC及FEV1/FVC显著下降（P<0.001）。在健康受试者中，FEV1和FVC显著下降（P<0.001），而FEV1/FVC未下降。哮喘患者BAL后FEV1的下降幅度（32.4±10.0%）显著大于健康受试者（17.7±4.6；P<0.001）。哮喘严重程度、基线FEV1或初始PaO2均不能预测低氧血症程度或FEV1的下降。结论是，与健康受试者相比，BAL在哮喘患者中导致更严重的低氧血症和FEV1更大幅度的下降，有力支持了在哮喘患者进行BAL时应特别谨慎并仔细监测的建议。
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