- 期刊
Pulmonary Alveolar Proteinosis Treated with Multiple Selective Lobar Lavage by Bronchofiberscopy: A Case Report
多次光纖支氣管內視鏡選擇性肺葉沖洗術治療肺泡蛋白質沈著症－病例報告
摘要
肺泡蛋白質沈著症(pulmonary alveolar proteinosis, PAP)是少見的疾病。全肺沖洗術(whole lung lavage, WLL)仍是現今標準的治療方式。而使用光纖支氣管內視鏡選擇性的肺葉沖洗術是另一個選擇的方式。我們報告一個蛋白質沈著症患者在胸腔內視鏡肺葉切片手術後使用支氣管內視鏡作多次肺葉沖洗術的經驗。因為低血氧以及氧合飽和度下降，病患無法執行全肺沖洗術。所以我們選擇兩邊分開24小時執行各兩次的光纖支氣管內視鏡肺葉沖洗術。每次以2000毫升的溫暖生理食鹽水從支氣管鏡注入，並伴隨徒手胸腔敲擊(chest percussion)後抽回，在加護病房內監視以及鎮靜藥物的使用下執行。病患對執行過程忍受度良好並且在手術後第七天拔管。我們的經驗顯示，光纖支氣管內視鏡肺葉沖洗術對無法容忍全肺沖洗術的蛋白質沈著症患者來說，是有效且安全的治療方式。
並列摘要
Pulmonary alveolar proteinosis (PAP) is a rare disease. The current standard treatment for PAP is whole-lung lavage (WLL). An alternative procedure is selective lobar lavage by bronchofiberscopy. We report our experience with bronchofiberscopic lobar lavage in treating a patient with PAP that was diagnosed by wedged resection via video-assisted thoracoscopic surgery (VATS). Due to hypoxemia and de-saturation, the patient could not tolerate the WLL procedure herefore, we performed lobar lavage by bronchofiberscopy for each side twice at 24 hours interval. Approximately 2,000 ml of warm normal saline solution was instilled for each cycle of lavage, combined with manual chest percussion under sedation and mechanical ventilator support in the intensive care unit (ICU). The patient withstood the entire procedure well and the endotracheal tube was removed on the 7(superscript th) post-operative day. In our experience, bronchofiberscopic lobar lavage can be safely and effectively performed for those patients with PAP who cannot tolerate WLL.
延伸閱讀
- Liu, C. C., & Chang, S. C. (2007). 支氣管肺泡灌洗術診斷肺Nocardiosis在一周邊血液幹細胞移植後病患－病例報告. 胸腔醫學, 22(6), 422-427. https://doi.org/10.29806/TM.200712.0008
- Tseng, C. H., Hsu, J. Y., & Fu, P. K. (2013). 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. 胸腔醫學, 28(1), 57-64. https://www.airitilibrary.com/Article/Detail?DocID=10239855-201302-201302220027-201302220027-57-64
- Wang, Y. C., Lu, J. Y., Kuo, W. S., Chung, M. T., & Yeh, P. F. (2010). 肺泡蛋白質沈著症在加護病房進行全肺灌洗術治療. 重症醫學雜誌, 11(4), 267-274. https://doi.org/10.30035/TCCM.201012.0005
- Chung, C. Y., Chen, C. K., Liu, H. P., Ho, A. C., Yung, M. W., & Chou, A. H. (2012). 肺泡蛋白質沉積症進行全肺部沖洗術之病例報告. 中華民國急救加護醫學會雜誌, 23(4), 162-168. https://doi.org/10.30018/JECCM.201212.0006
- Tsai, T. C., Hung, C. C., Chen, M. S., He, C. C., Kuo, M. C., & Hsieh, S. W. (2004). 肺泡蛋白質沉積症進行全肺部沖洗術之病例報告. Acta Anaesthesiologica Taiwanica, 42(1), 49-54. https://www.airitilibrary.com/Article/Detail?DocID=02541319-200403-42-1-49-54-a