FLUID-DYNAMICS DURING BRONCHOALVEOLAR LAVAGE
FLUID-DYNAMICS DURING BRONCHOALVEOLAR LAVAGE
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DOI：
10.1164/ajrccm/138.1.81
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发表时间：
1988-07-01
期刊：
影响因子：
--
通讯作者：
WALTERS, EH
中科院分区：
文献类型：
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作者：
KELLY, CA;FENWICK, JD;WALTERS, EH
一系列相关研究旨在调查和量化标准化支气管肺泡灌洗（BAL）过程中发生的肺段和肺泡或肺循环之间的液体交换程度。在5名受试者中进行了3次60 ml BAL，使用锝胶体和亚甲蓝计算引入液体的稀释度约为25%。因此，总稀释体积约为225 ml。在同一实验中，将氚化水掺入引入的流体中，并将抽吸物中氚的稀释程度与其他2种标记物的稀释程度进行比较。氚的稀释度大于预期，表明BAL期间约有55 ml水从肺段流出。因此，BAL期间该段的总液体增量约为100 ml（稀释体积的44%），尽管BAL前肺内液体对该体积的贡献尚不清楚。3.时间另外5名患者在口服氚水后12 h进行60 ml BAL程序。同时测定血浆和抽吸物中尿素（稀释的假定“内源性标记物”）的浓度。根据这些值，计算出通常驻留在肺段中的液体最多占总抽吸体积的约2%。通过同时测量血浆和灌洗吸出物中的氚浓度，计算出85 ml吸出物中39%的中位数来自循环或周围的氚。这证实了先前研究中观察到的抽吸物稀释主要是由于流入肺段的净液体增加。这些研究首次在人类受试者中对标准化BAL的复杂流体动力学进行了定量分析。
A series of related studies were designed to investigate and quantify the degree of fluid exchange between the lung segment and the interstitium or pulmonary circulation that occurred during a standardized bronchoalveolar lavage (BAL). In 5 subjects undergoing a 3 .times. 60 ml BAL, the dilution of introduced fluid was calculated at approximately 25% using both technetium colloid and methylene blue. Thus, there was a total dilution volume of about 225 ml. In the same experiment, tritiated water was incorporated into the introduced fluid, and the degree of dilution of tritium in the aspirate was compared with that of the other 2 markers. The dilution of tritium was greater than anticipated, suggesting that around 55 ml of water had effluxed from the lung segment during BAL. The total fluid gain by the segment during BAL was thus approximately 100 ml (44% of the dilution volume), although the contribution of fluid resident in the lung prior to BAL to this volume was not known. The 3 .times. 60 ml BAL procedures were performed in a further 5 patients 12 h after they had received tritiated water orally. The concentration of urea, a putative "endogenous marker" of dilution, was assayed simultaneously in plasma and aspirate. From these values the fluid normally resident in the lung segment was calculated to contribute at most about 2% of the total aspirated volume. A median of 39% of the 85 ml aspirated was calculated to have come from the circulation or surrounding interstitium by simultaneous measurements of the concentrations of tritium in plasma and lavage aspirate. This confirmed that the dilution of the aspirate observed in the previous studies was largely due to a net fluid gain from flux into the lung segment. These studies offer, for the first time in human subjects, a quantitative analysis of the complex fluid dynamics of a standardized BAL.