肺泡蛋白沉积症支气管肺泡灌洗的麻醉管理:病例报告

Abinav Sarvesh S P S, S. Gaiwal, Nimitha Prasad
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摘要

:肺泡蛋白沉积症(PAP)是一种非常罕见、危及生命的非炎症性弥漫性肺部疾病,其特点是肺泡内脂蛋白物质密集堆积,导致低氧血症和限制性肺病,进而引发呼吸衰竭。全肺灌洗(WLL)被认为是首选的治疗方法,包括在肺部注入温生理盐水,然后将其与脂蛋白物质一起排出,从而清除阻塞。WLL 需要麻醉师、肺病专家和物理治疗师之间良好的团队合作。手术过程在许多方面都具有挑战性,如低氧血症和血液动力学波动。术后通常需要短期机械通气:一名 45 岁的女性被诊断为 PAP 病例,她在休息时出现呼吸困难,且需氧量不断增加。经过临床检查和化验后,由于病情严重,计划进行左肺支气管肺泡灌洗(BAL),几天后再进行右肺 BAL。在手术过程中,发现饱和度降低到 78%。经过精心纠正,饱和度有所回升,手术顺利完成。术后患者接受了机械通气,32 小时后拔管:WLL是PAP的首选治疗方法,涉及多学科方法,面临多重挑战。术前吸氧、使用左侧双腔管(DLT)进行充分的肺隔离、使用呼气末正压(PEEP)进行单肺通气、术中密切监测、谨慎使用体位操作和招募操作以及良好的团队合作是取得成功的关键。
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Anesthetic management of broncho- alveolar lavage in pulmonary alveolar proteinosis: A case report
: Pulmonary alveolar proteinosis (PAP) is a very rare, life threatening, noninflammatory, diffuse lung disorder characterized by dense accumulation of lipo-proteinaceous material within the alveoli causing hypoxemia, restrictive lung disease leading to respiratory failure. Whole lung lavage (WLL) is considered as the treatment of choice which includes infusing warm saline in the lungs and draining it out with the lipo-porteinaceous materials thereby clearing the obstruction. WLL requires good team co-ordination between the anaesthesiologists, pulmonologists and physiotherapists. The procedural course is challenging in many aspects like hypoxaemia and hemodynamic fluctuations. Post procedure short term mechanical ventilation is commonly required.: A 45 year old female, diagnosed case of PAP presented with dyspnea at rest with increasing oxygen requirement. After clinical examination and investigations, due to severity of the disease, broncho-alveolar lavage (BAL) of left lung was planned with subsequent right lung BAL after few days. During the procedure, desaturation upto 78% was noted. With meticulous corrective measures, saturation picked up and the procedure was completed uneventfully. Post-operatively patient was mechanically ventilated and extubated after 32 hours.: WLL is the treatment of choice for PAP which involves multidisciplinary approach with mulitple challenges. Pre-oxygenation, adequate lung isolation with left sided double lumen tube (DLT), one lung ventilation with positive end expiratory pressure (PEEP), vigilant intra-operative monitoring, cautious use of positional manoeuvres and recruitment manoeuvres with a good teamwork is the key for successful outcome.
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