支气管肺泡灌洗课件长海医院

1长海医院呼吸内科黄怡定义 支气管肺泡灌洗（Bronchoalveolar Lavage，BAL）利用纤维支气管镜向支气管肺泡内注入生理盐水并随即抽吸，收集肺泡表面衬液，检查其细胞成份和可溶性物质的一种方法。主要用于对有关疾病的临床诊断以及研究肺部疾病的病因、发病机制、评价疗效和预后等。发展简史 1828年Green开始探索气管插管的可能性并注入液体进入支气管； 1904年Chevalier Jackson在支气管镜远端装置光源和安置吸引管，促进了硬质支气管镜的发展；发展简史 1964年Shiigaeo Lkeda发明纤维支气管镜并使用于临床为BAL打下基础； 1974年Reynolds与Newball等发展了支气管肺泡灌洗技术（治疗肺泡蛋白沉积症）。2临床分类 支气管肺泡灌洗检查术（BAL） 治疗性支气管肺泡灌洗术 全肺灌洗（whole lung lavage) 大容量全肺灌洗(massive pulmonary lavage) 低容量全肺灌洗（Volume controlled pulmonary lavage) 肺叶支气管肺泡灌洗（Lobulous bronchoalveolarlavage,LBAL)适应证--肺泡蛋白沉积症、矽肺、尘肺、肺泡微石症、哮喘持续状态等的治疗。支气管肺泡灌洗(Bronchoalveolar lavage)与支气管冲洗(Bronchial washings )区别Procedu re commonly includes bronchial washings for cytology, fungi, and acid-fast bacilliProcedure Name Bronchial Washings Techniqu e the bronchoscope is passed in the usual manner. Isotonic saline is instilled through the inner channel of the bronchoscope. Fluid is aspirated into a trap connected in-line to the suction tubing. Procedure Name Bronchial WashingsUsually 2-5 ml aliquots of fluid are instilled with each washingand approximately one-fourth to one-half of this volume is recovered. Procedure Name Bronchial Washings3 For endoscopicallyvisible lesions, the fluid is washed directly over the area in question. For lesions which are not visible, the bronchoscope is wedged in the respective segment and washings are aspirated. For tumors which are diagnosed on sputum cytology, but remain radiographicallyand endobronchiallyinvisible, washings of each segment can...