【摘要】 目的评估急性呼吸窘迫综合征(ARDS)患者进行支气管镜肺活检(TBLB)的安全性和诊断价值。方法回顾性分析2003年1月～2007年9月在广州呼吸疾病研究所ICU做TBLB检查的8例ARDS患者的临床资料。结果4例(50%)患者经TBLB确诊。侵袭性肺曲霉菌感染1例(12.5%)、放射性肺炎1例(12.5%)、混合性结缔组织疾病肺间质纤维化表现1例(12.5%)、肺结核1例(12.5%)。ARDS患者非特异性病理改变4例(50%)。3例(37.5%)患者因此更改了治疗方案。TBLB的并发症包括:出血<30mL者5例(62.5%)、出血≥30mL者3例(37.5%)、低氧血症7例(87.5%)、低血压3例(37.5%)、心跳过速1例(12.5%)、无气胸及患者死亡。结论在ARDS患者进行支气管镜肺活检有一定风险和诊断价值,在严格掌握适应证的情况下,可以作为肺活检选择。更多还原

【Abstract】 【Objective】To evaluate the safety and diagnostic value of transbronchial lung biopsy(TBLB)performed in acute respiratory distress syndrome(ARDS) patients.【Methods】TBLB was performed in 8 mechanically ventilated ARDS patients from January 2003 to September 2007 in the ICU of Guangzhou Institute of Respiratory Diseases.The results of clinical data were retrospectively analyzed.8 patients were analyzed.【Results】Specific diagnoses were made with the transbronchial lung biopsies in 4 cases(50%).The diseases included pulmonary aspergillus pneumonia in 1 cases(12.5%),radioactive pneumonia in 1 case(12.5%),pulmonary interstitial fibrosis of mixed connective tissue disease in 1 case(12.5%) and pulmonary tuberculosis in 1 case(12.5%).ARDS lung tissue nonspecific changes were found in 4 cases(50%).The treatment was changed according to the result of TBLB in 3 patients(37.5%).Complications associated with this procedure included the following:bronchial hemorrhage <30 mL in 5(62.5%) episodes,bronchial hemorrhage ≥30 mL in 3(37.5%) cases,transient oxygen desaturation in 7 cases(87.5%),hypotension in 3 cases(37.5%),and tachycardia in 1(12.5%) case.There were no deaths nor episodes of pneumothorax.【Conclusions】 Transbronchial lung biopsy can be performed safely and has a diagnostic value in ARDS patients.TBLB should be considered as a diagnostic procedure for lung biopsy.更多还原