Clinical Study Of Treatment On Early Stages Pneumoconiosis With Massive Whole Lung Lavage

1.BackgroundPneumoconiosisis an occupational diseases of clear cause, despite its therapy methods are explored ongoing by scholars in domestic and foreign,but is still considered to be an incurable disease.In the 1980s,Mason and his colleagues was the first to apply whole lung lavage(WLL) (either one lung per session or two sequential whole-lung lavages under one anesthesia session)in the treatment of a mixed-dust pneumoconiosis,which is in the operating room undergeneral anesthesia using a double-lumen endotrachealtube,and this technology was introduced in china to practice in experimental and clinical research on pneumoconiosis in 1986.Since January 1993 the technology was introduced by State Grid Corporation Occupational Disease Hospital,clinical study of the treatment of 571 case's lavages in the power industry pneumoconiosis patients by WLL has been successfully completed.To evaluate the therapeutic value and significance of WLL on early stages pneumoconiosis and observe clinical effects,the study uses retrospective methods,sums up information of all early stages pneumoconiosis(including 0+andⅠstages)with WLL among the 10 years from 1993 to 2002 according to follow-up data.2.Materials and MethodsA retrospective analysis of clinical data in the treatment of WLL on early stages pneumoconiosis were collected among 10 years from January 1993 to December 2002.The 275 times lavages of 172 cases of early stages pneumoconiosis were divided into three groups including bilateral sequential WLL,bilateral discontinuous WLL and unilateral WLL. Summary of clinical symptoms,lung function,chest X-ray examination,laboratory findings of the recovered lavage fluid,intra-and post-operative lavage records,and complete follow-up information were collected.Clinical symptoms,lung function and chest X-ray findings after 1,2,5 and 10 years were compared with the data of preoperative.3.ResultsThe 275 times lavages of 172 cases of early stages pneumoconiosis consisted of 288 lungs.The average each lung lavage was 9.78±0.89 times,the total volume 8.65±1.04L,pulmonary residual 616.6±329.76ml and lavage time 31.48±6.33 minutes,which stageⅠpneumoconiosis was slightly longer period than0+(P＜0.05).Acertain amount of dust,free silica and swallowing dust pulmonary alveolar macrophages could be eliminated by WLL in the treatment on early stages pneumoconiosis,which the dust and free silica average of 485.06±685.22mg and 209.27±212.17mg in each lung of pneumoconiosisⅠStage and 0+ pneumoconiosis(227.34±117.72mg and 8.92±4.87mg)were removed respectively,which was statistically different (P＜0.01);total removal of cells were 8.45×10~7 and 9.48×10~7 respectively,swallowing dust pulmonary alveolar macrophages were over 92%.The intra-and post-operative complication rates of bilateral sequential WLL were significantly higher than both the unilateral and bilateral discontinuous WLL(P＜0.05).After an improvement in clinical symptoms in both pneumoconiosis 0+andⅠstages,its efficiency was above 55%,but no difference between the two groups.The rate of stability of chest X-ray was no more difference between unilateral and bilateral sequential WLL in the time points of 1,2,5 and 10 years,but the rate of aggravation of pneumoconiosis 0+stage was faster thanⅠstage in 2 and 5 years(2 years:P＜0.05;5:P＜0.01).Pulmonary ventilation function down in 1,2,5 and 10 years were compared with the preoperative,but not statistically significant(P＞0.05).4.Conclusions(1)Early stages pneumoconiosis bronchoalveolar cavity deposition of dust,free silica and swallowing dust pulmonary alveolar macrophages are removed by WLL,which lung silica dust load are reduced,WLL have therapeutic effect on early stages pneumoconiosis through washed out dust and other materials,which delaying deterioration of the disease.(2)Clinical symptoms of early stages pneumoconiosis may be improved to a certain extent,but there are no evidences of amending of lung function in 1,2,5 and 10 years after WLL.(3)Intra-and post-operative hypoxemia and pulmonary ventilationside leakageare the major adverse reactions. The security risks of bilateral sequential WLL are relatively larger.WLL is a safe therapeutic technology in a hospital with conditions and experienced.