目的 评估全肺灌洗技术对肺泡蛋白沉着症(PAP)患者的疗效及安全性,并对疗效预测因素进行分析.方法 分析2000年1月至2016年11月36例PAP患者行全肺灌洗术治疗前后的呼吸困难症状评分(MMRC评分)、肺功能、动脉血气分析及胸部影像学变化,依据灌洗术后MMRC评分改善情况分为改善组和无效组,并对两组患者一般资料及灌洗术中相关指标进行比较,评估全肺灌洗术治疗过程的安全性.结果 经全肺灌洗术后,患者肺功能、MMRC评分、血气分析指标及影像学方面均较术前明显改善,差异有统计学意义(P<0.05).其中改善组26例,无效组10例,两组患者在合并慢性支气管炎比例(%)、灌洗前MMRC评分、术中低氧血症比例(%)以及灌洗持续时间方面比较,差异均有统计学意义(P<0.05).36例患者均安全完成全肺灌洗术,灌洗过程中患者生命体征较平稳,未出现严重并发症.结论 全肺灌洗术治疗PAP疗效确切,安全性好,但对于合并慢性支气管炎和严重呼吸困难的患者效果欠佳,灌洗过程中应注意避免低氧血症发生和灌洗时间过长.%Objective To evaluate the efficacy and safety of whole lung lavage in treatment of pulmonary alveolar proteinosis(PAP),and the factors for predicting clinical responses.Methods 36 cases of patients who diagnosed as PAP from Jan 2000 to Nov 2016 in Xinjiang autonomous region occupational disease hospital were recruited in the study.The changes of dyspnea symptom,lung function,arterial blood gas and chest image were compared before and after whole lung lavage treatment. According to MMRC score improvement situation,they were divided into improved group and invalid group,the general information and related indicators during the operation were compared in two groups.Meanwhile,the safety of whole lung lavage was evaluated.Results The lung function,MMRC score,hypoxia,hyperventilation and chest image were all obviously improved(P<0.05). According to MMRC score improvement situation,36 cases were divided into improved group(26 cases) and invalid group(10 cases). Accompanied chronic bronchitis percentage(%),MMRC score before whole lung lavage and irrigation duration were compared in two groups,the differences were statistically significant(P<0.05). The vital signs in the process of lung lavage were stable without serious complication. Conclusions The whole lung lavage is an effective and safe treatment for PAP,but the clinical effect for patient with chronic bronchitis or severe dyspnea may be poor,and should pay attention to avoid hypoxemia and overlong irrigation time during lavage process.
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