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目的探讨大容量全肺灌洗术中肺顺应性的变化。方法选择各期煤工尘肺及矽肺患者252例,其中合并慢性支气管炎(以下简称慢支)73例、无慢支的179例,采用规范的大容量全肺灌洗术进行治疗,监测术前、灌洗毕、第二肺灌洗前、停止麻醉前每侧肺的动态顺应性及灌洗毕肺顺应性恢复时间;观察肺顺应性与病变期别及合并症的关系。结果Ⅰ期、Ⅱ期、Ⅲ期术前肺顺应性分别为(38.3±8.2)、(36.8±7.0)、(39.1±10.3)ml/cmH2O,灌洗毕肺顺应性分别为(20.6±6.4)、(20.1±5.5)、(19.2±1.4)ml/cmH2O,较术前下降,差异有统计学意义(P<0.01)。灌洗侧肺恢复时,肺顺应性Ⅰ期(31.4±6.6)ml/cmH2O、Ⅲ期(26.2±1.4)ml/cmH2O,较术前下降,差异有统计学意义(P<0.01)。不同期别通气肺在肺灌洗术毕和灌洗侧肺恢复时,肺顺应性较术前下降,差异无统计学意义(P>0.05)。Ⅰ期尘肺合并慢支者,肺顺应性术前(36.6±7.7)ml/cmH2O、术毕(20.6±6.4)ml/cmH2O及灌洗肺恢复时(32.7±7.7)ml/cmH2O,比无合并症者肺顺应性术前(39.1±8.2)ml/cmH2O、术毕(22.6±5.7)ml/cmH2O及灌洗肺恢复时〔(34.9±5.8)ml/cmH2O〕均降低,差异有统计学意义(P<0.05);Ⅱ期、Ⅲ期尘肺有无合并慢支者肺顺应性比较,差异无统计学意义(P>0.05)。不同期别患者灌洗侧肺顺应性恢复时间Ⅰ期(78.4±20.1)min,Ⅱ期(108.0±25.2)min,Ⅲ期(110.2±27.6)min,随着期别的增加而延长,差异有统计学意义(P<0.05)。结论大容量全肺灌洗术可导致肺顺应性降低,Ⅱ期和Ⅲ期尘肺受影响更大;期别越高,灌洗侧肺顺应性恢复时间越长。
Objective To investigate the changes of lung compliance during high-volume total lavage. Methods A total of 252 patients with pneumoconiosis and silicosis were selected in this study. Of them, 73 cases were complicated with chronic bronchitis (hereinafter referred to as chronic bronchitis) and 179 cases without chronic bronchitis were treated with standard large-capacity whole lung lavage. , Lavage completed, before the second lung lavage, to stop the dynamic compliance of each side of the lung before anesthesia and laparoscopic lung compliance recovery time; observed lung compliance and lesions and complications and complications. Results The preoperative lung compliance of stage Ⅰ, Ⅱ, and Ⅲ were (38.3 ± 8.2), (36.8 ± 7.0) and (39.1 ± 10.3) ml / cmH2O, respectively. , (20.1 ± 5.5) and (19.2 ± 1.4) ml / cmH2O, respectively, which were significantly lower than those before operation (P <0.01). The lung compliance was significantly higher in stage Ⅰ (31.4 ± 6.6) ml / cmH2O and stage Ⅱ (26.2 ± 1.4) ml / cmH2O than in control group (P <0.01). Lung ventilation at different stages of lung lavage and lavage at the completion of perfusion lung recovery, lung compliance than preoperative decline, the difference was not statistically significant (P> 0.05). Patients with stage Ⅰ pneumoconiosis complicated with chronic bronchitis had lung compliance of (36.6 ± 7.7) ml / cmH2O at the end of operation (20.6 ± 6.4) ml / cmH2O and (32.7 ± 7.7) ml / Symptomatic lung compliance (39.1 ± 8.2) ml / cmH2O, 22.6 ± 5.7 ml / cmH2O at the time of surgery and [(34.9 ± 5.8) ml / cmH2O) (P <0.05). There was no significant difference in lung compliance between stage Ⅱ and stage Ⅲ pneumoconiosis with or without chronic bronchitis (P> 0.05). The recovery time of lung compliance during the first laparoscopic operation in patients of different stages was (78.4 ± 20.1) min, in the second stage (108.0 ± 25.2) min, and in the third stage (110.2 ± 27.6) min, which increased with the increase of the stage Statistical significance (P <0.05). Conclusions Large-capacity whole-lung lavage can lead to decreased lung compliance and more severe pneumoconiosis in stage Ⅱ and Ⅲ. The higher the stage, the longer the recovery time of lung compliance.