Discuss The Effection Of High Frequency Ventilation Aided With The Whole Lung Lavage To Patients Of Pulmonary Alveolar Proteinosis

Background and Objective:Pulmonary alveolar proteinosis(PAP) is a rare unknown etiology diffuse pulmonary disease. Although there are many researches about the pathogenesis of PAP in recent years,it is still unclear.We can't treat the disease by etiological treatment.The whole lung lavage(WLL) is accepted the most effective treatment methods at present. Most patients of PAP were treat by WLL can obviously relieve the symptoms. There are still part of the PAP patients can't get the satisfying effection,although the symptoms can be relived partly. The image improving is not obvious either,it should be related with the WLL can't remove alveoli effectively. For this part of the PAP patients, how to improve the treatment ettection of the WLL will be very important.The whole lung lavage is a technology of alveolar lavaging with physiological saline under a general anesthesia . Since Ramirez doctor who was from U.S.A Baltimore became the first one to applied WLL for 3 PAP patients successfully. That the diagnosis of PAP and use WLL to treat it has been recognized at home and abroad.Our hospital has been treated dozens of PAP patients already,most of them had a good result. But a few of them were inefficient, and they need to be treat by WLL repeatedly. In addition, in the implementation of the lung lavage process, some patients will appear serious low oxygen blood oxygen, and even hard to fulfill the lung lavage. There are many related researches about the improvement of WLL Both at home and abroad. And it had made some progress of the effedtion, but still existed some shortage. So it is very important to study how to improve the WLL that in order to improve the efficiency and to improve the SpO₂ to make the WLL can be completed smoothly.Some researches had been proved that it can improve the efficiency of clearing the alveoli deposition to use artificially chest striking assist with the WLL. This experiment is to auxiliarily use high frequency ventilation(HFV) just after uder-going the WLL,and explore if it can improve the efficiency of clearing the alveoli deposition and improve the SpO₂ of the patients while lavaging.Comparing the efficiency of manual chest percussion(MN) just afer uder-going the WLL ,HFV just after uder-going the WLL, the conventional (CN)WLL.This experiment is divided into two parts. The first part: to explore the efficiency of clearing alveoli deposition by high frequency ventilation auxiliary lung lavage to treat the PAP patients.Part 2: to explore the degree of improving the SpO₂ of the PAP while under-going high frequency ventilation auxiliary lung lavage.PartⅠdiscuss the efficiency of clearing alveoli deposition by high frequency ventilation aided with lung lavage to treat the PAP patientsAim:explore the efficiency of clearing alveoli deposition by high frequency ventilation auxiliary lung lavage to treat the PAP patients.Research object3 PAP patients who are diagnosis by BALF or TBLB.Time from May 2010 to March 2011 in our hospital.Age from 20 to 50 years old. Moderate to severe hypoxemia, and daily activities limited . There have no heart, liver, kidney and other important organ dysfunction. Methods:We classifh lung lavage methods into three kinds.methodA:conventional WLL (make 1000ml 37℃physiological saline infused into the lung directly,stay 2 min,then take back the BALF by the negative pressure aspirator under -20kPa pression for 4 min.).methodB: conventional WLL+HFV(after making 1000ml 37℃physiological saline infused into the lung directly, Keeping airway open, use a HFV machine to ventilate in the lung through a duct for 2min ,under the frequency of 240times/min, 0.02-0.04MPa pression. And then take back the BALF by the negative pressure aspirator under -20kPa pression for 4 min.make sure the venting duct be put in the distal end of the the main bronchi and not more than the open of the upper lobe bronchus).methodC: conventional WLL+manual chest percussion(MN) (after making 1000ml 37℃ physiological saline infused into the lung directly,begin to carry out MN for 2 min at a rate of 180-270 times/min over the anterior and anterolateral chest wall, then take back the BALF by the negative pressure aspirator under -20kPa pression for 4 min.).WLL for 6 times.The first to the fourth bottles of saline will be carried out by the conventional WLL.From the fifth to the thirteenth bottles of saline will be randomly carried out by the ways above alternately.We will pick out the bottles of BALF from number 5 to number 13 to be analysed,there will be 54 bottles altogether. We will check the 280nm dential densite(OD) of erery bottle of BALF by the spectrophotometer,and analyse all the data. We will compare the arterial blood gas, pulmonary function, imaging befor WLL with that after WLL.Result:There are significantly linear relationshipbetween the concentration and the 280nmOD value of BALF. (R2 = 0.9803, P = 0.000).we can get the BALF's concentration indirectly by it's 280nm OD value.Compare with the method A (0.189±0.0846),the efficiency of method B and C is improved significantly.Their 280nm OD value are 0.363±0.1561 and 0.344±0.1566. There is significant difference in statistic(P = 0.001,P = 0.003).Compare with methodC,the efficiency of lung lavage is not improved obviously in method B. there has no significant difference in statistic(P = 0.977). The score of shortness of breath index before lung lavage is 3.0±1.0.After the lavage,the score is 1.3±0.6. There is significant difference in statistic(P=0.038).The PaO₂ before lavage is 52.8±7.9.After the lavage it is 86.0±16.4. There is significant difference in statistic(P=0.038).The DLCO before lung lavage is 10.21±0.74.And after lavage,the data is 13.16±0.7. There is significant difference in statistic(P=0.035). The chest HRCT is improved after lung lavage. Conclusion:HFV assist with WLL and manual chest percission assist with are effective for PAP.Coparing with the conventional WLL,they can improve the efficiency of clearing the alveoli deposition. explore the degree of improving the SpO₂ of the PAP while under-going high frequency ventilation auxiliary lung lavageAim:explore the degree of improving the SpO₂ of the PAP while under-going high frequency ventilation auxiliary lung lavage. Research object3 PAP patients who are diagnosis by BALF or TBLB.Time from May 2010 to March 2011 in our hospital.Age from 20 to 50 years old. Moderate to severe hypoxemia, and daily activities limited . There have no heart, liver, kidney and other important organ dysfunction. Methods:We classifh lung lavage methods into three kinds. methodA:conventional WLL (make 1000ml 37℃physiological saline infused into the lung directly,stay 2 min,then take back the BALF by the negative pressure aspirator under -20kPa pression for 4 min.).methodB: conventional WLL+HFV(after making 1000ml 37℃physiological saline infused into the lung directly, Keeping airway open, use a HFV machine to ventilate in the lung through a duct for 2min ,under the frequency of 240times/min, 0.02-0.04MPa pression. And then take back the BALF by the negative pressure aspirator under -20kPa pression for 4 min.make sure the venting duct be put in the distal end of the the main bronchi and not more than the open of the upper lobe bronchus) .methodC: conventional WLL+manual chest percussion(MN) (after making 1000ml 37℃physiological saline infused into the lung directly,begin to carry out MN for 2 min at a rate of 180-270 times/min over the anterior and anterolateral chest wall, then take back the BALF by the negative pressure aspirator under -20kPa pression for 4 min.).WLL for 6 times.The first to the fourth bottles of saline will be carried out by the conventional WLL.From the fifth to the thirteenth bottles of saline will be randomly carried out by the ways above alternately. We will check the change of SpO₂, CVP, HR and MAP by lavaged with three methods above.And record volume of returen liquid afrer lavage by each method. Then analyse all the data collected. Result:1.The SpO₂ before lung lavage by method A is 95.7±1.9.And after lavage is 95.3±1.9. There is no significant difference in statistic(P=0.518). The SpO₂ before lung lavage by method B is 94.1±3.29. And after lavage is 99.8±0.5. There is significant difference in statistic(P=0.000). The SpO₂ before lung lavage by method C is 95.6±2.1. And after lavage is 94.9±2.2.. There is no significant difference in statistic(P=0.231).2.The volume of returen liquid afrer lavage by method A is 924.7±6.1.The volume of method B is 916.7±6.6. The volume of method C is 919.2±5.8.Comparing with method A, method B and method C has significant difference in statistic (P=0.000,P=0.009).There is no significant difference in statistic (P=0.229) between method B and method C.3.The CVP before lung lavage by method A is 11.2±1.6.And after lavage is 11.7±1.6. There is no significant difference in statistic(P=0.248). The CVP before lung lavage by method B is 11.7±1.4.And after lavage is 2.8889±1.1827. There is significant difference in statistic(P=0.000). The CVP before lung lavage by method C is 11.1667±1.6891.And after lavage is 11.9±1.6. There is significant difference in statistic(P=0.011).4.The HR before lung lavage by method A is 89.2±6.0.And after lavage is 89.5±6.4. There is no significant difference in statistic(P=0.399). The HR before lung lavage by method B is 88.9±5.8.And after lavage is 89.9±6.4. There is significant difference in statistic(P=0.037). The HR before lung lavage by method C is 89.8±5.7.And after lavage is 90.6±6.0. There is significant difference in statistic(P=0.043).5.The MAP before lung lavage by method A is 84.2±6.4.And after lavage is 84.9±7.6. There is no significant difference in statistic(P=0.376). The MAT before lung lavage by method B is 88.2±7.0.And after lavage is 86.9±7.5. There is no significant difference in statistic(P=0.372). The CVP before lung lavage by method C is 89.6±6.9.And after lavage is 90.7±7.7. There is no significant difference in statistic(P=0.351).6.There are no complications before and after lung lavage,such as Pneumonia, cardiac insufficiency, pneumothorax, mediastinum emphysema,et al.Conclusion:HFV assist with WLL(B method) can improve the SpO₂ significantly while lavaging. A method and C method both can not improve the SpO₂ significantly while lavaging,. The volume of liquid absorbed increase by HFV ,it can cause some change in the hemodynamics(such as CVP,HR) while lavaging. But it can be treated effectively,such as using some diuretic. There are no complications before and after lung lavage. HFV assist with WLL is still safe and effective.