摘要目的 探讨全肺灌洗术(WLL)治疗肺泡蛋白沉积症(PAP)围手术期安全性.方法 回顾性分析广州呼吸疾病研究所2006年1月至2016年8月应用WLL治疗的78例次PAP患者的临床资料,分析围手术期的并发症及原因.结果 共有18例次(18/78,23.07％)出现术中或术后并发症,包括胸腔积液4例次、感染4例次、心力衰竭2例次、心律失常2例次、气胸2例次,以及肺不张、肺水肿、喉头水肿、胸腔积液并肺部感染各1例次.及时给予针对性处理后,所有患者完全恢复.74例次灌洗后顺利拔管,4例次灌洗后拔管时间延长,最长延长至4d后拔管.并发症的发生与年龄、术前DSS评分、术前血二氧化碳分压、术前FEV1、灌洗量、灌洗次数和基础病等指标无明显相关(P＞0.05),而高灌洗回收率对并发症的发生有保护作用(Wald=7.672,OR ＜0.01,P＜0.05).结论 WLL治疗PAP围手术期安全性高,也有一定的并发症,与灌洗的回收率呈负相关,及时针对性处理可恢复.熟练掌握灌洗技术,规范操作,术后密切观察,发生并发症后应及时处理.

abstractsObjective To evaluate the safety of the procedures of whole lung lavage (WLL) for pulmonary alveolar proteinosis (PAP) in perioperative period.Methods In this retrospective study,we collected clinical data from 78 WLL procedures of PAP patients from January 2006 to June 2016 in Guangzhou Institute of Respiratory Disease.The causes of perioperative complications were analyzed.Results Eighteen (23.07％) of the 78 procedures developed complications,including pleural effusion(n =4),pneumonia(n =4),cardiac failure (n =2),cardiac arrhythmia (n =2),pneumothorax (n =2),atelectasis(n =1),lung edema(n =1),laryngeal edema(n =1),pleural effusion and pneumonia(n =1).All complications were mild and easy to treat.Seventy-four procedures had successful extubation,but 4 procedures developed a prolonged time of extubation.Age,DSS,PaCO2,FEV1,lavage volume,lavage times and underlying diseases were not predictors for any complications (each P ＞ 0.05).High fluid recovering rate had a protective effect against the occurring of complications (Wald =7.672,OR ＜ 0.01,P ＜ 0.05).Conclusions Whole lung lavage was a safe procedure in the treatment of PAP.Complications could recovery after proper therapy.The perioperative complications showed a correlation with low fluid recover rate.Operation under guideline was the key to avoid complications.