Pulmonary Physiology before and after Bronchopulmonary Lavage for Pulmonary Alveolar Proteinosis-A Case Report

肺泡蛋白沉積症的支氣管肺泡灌洗前後生理參數變化－病例報告

曾健華(Chien-Hua Tseng) ； 許正園(Jeng-Yuan Hsu) ； 傅彬貴(Pin-Kuei Fu)

《胸腔醫學》 28卷1期 (2013/02) Pp. 57-64

摘要

肺泡蛋白沉積症（PAP）是一種因肺泡累積脂蛋白物質導致瀰漫性肺疾病。對於中度至嚴重症狀和低血氧症患者，雖然支氣管肺泡灌洗是最被廣泛接受和有效的治療，但鮮少文獻討論支氣管肺泡灌洗前後的肺生理變化。我們報告一個病例：肺泡蛋白沉積症併發2個月呼吸衰竭，在接受2次支氣管肺泡灌洗治療後，成功脫離呼吸器，而我們也提出了一個處理嚴重肺泡蛋白沉積症的流程圖。在病患接受支氣管肺泡灌洗治療前後，我們記錄了呼吸參數及胸部X光片來探討支氣管肺泡灌洗對肺泡蛋白沉積症病患的肺部生理影響。最後，我們以繪圖的方式試著去形容肺泡及肺間質在支氣管肺泡灌洗的前後變化。這份報告是第一篇詳細討論支氣管肺泡灌洗前後肺部和呼吸參數的生理變化之相關文獻。

關鍵字

支氣管肺泡灌洗 ； 肺泡蛋白沉積症

並列摘要

Pulmonary alveolar proteinosis (PAP) is a diffuse lung disease characterized by the accumulation of lipoproteinaceous material in the alveoli. Although bronchopulmonary lavage (BPL) is the most widely accepted and effective treatment for patients with moderate to severe hypoxemia, there are few reports about the changes in pulmonary physiology before and after BPL. We report a rare case which was diagnosed as PAP with high plateau pressure. The patient received prolonged mechanical ventilation for 2 months, and was weaned from the ventilator after 2 sequential BPL sessions. We also propose an integrated algorithm which physicians can use when they perform BPL in such critically ill patients. In addition, we present the serial respiratory parameters and serial chest X-rays obtained before and after the BPL to highlight the impact of BPL on PAP in pulmonary physiology. Finally, we provide a figure to illustrate the morphological changes in the pulmonary alveoli and interstitial space, to explain the effect of BPL on PAP. This report is the first on the physiological changes in the lungs and the respiratory parameters before and after the implementation of BPL.

並列關鍵字

bronchopulmonary lavage ； pulmonary alveolar proteinosis ； plateau pressure ； pulmonary physiology