THE SAFETY ASPECTS OF FIBEROPTIC BRONCHOSCOPY, BRONCHOALVEOLAR LAVAGE, AND ENDOBRONCHIAL BIOPSY IN ASTHMA
THE SAFETY ASPECTS OF FIBEROPTIC BRONCHOSCOPY, BRONCHOALVEOLAR LAVAGE, AND ENDOBRONCHIAL BIOPSY IN ASTHMA
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DOI：
10.1164/ajrccm/143.4_pt_1.772
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发表时间：
1991-04-01
期刊：
影响因子：
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通讯作者：
HOWARTH, PH
中科院分区：
文献类型：
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作者：
DJUKANOVIC, R;WILSON, JW;HOWARTH, PH
我们记录了20名哮喘患者、8名健康非特应性对照组和8名特应性非哮喘患者在局部麻醉下纤维支气管镜联合支气管肺泡灌洗(BAL)和支气管内膜活检的生理效应。前用药包括雾化沙丁胺醇(2.5毫克；除特应性非哮喘受试者外)、溴化异丙托品(500-mU-g)和肌肉注射阿托品(0.6毫克)。静脉注射咪达唑仑用于轻度镇静，氧气通过鼻管输送。分别于用药前、用药后即刻、支气管镜检查后即刻、用药后2小时测定FEV1。在哮喘组(26.2+/-16.7%；p<；0.001)和正常组(9+/-4.7%，p<；0.05)中，支气管镜检查后即刻的平均(+/-SD)FEV1显著下降，在哮喘受试者中，这与支气管镜检查前5天测得的乙酰甲胆碱浓度导致FEV1(Pc20)下降20%呈负相关(r=-0.74，p<；0.001)，但与症状评分、沙丁胺醇的使用或调查前2周记录的最大呼气流量(PEF)变化无关。在哮喘患者的活检过程中，动脉血氧饱和度显著降低(中位数为3%，较基线下降-1%至17%；p<；0.01)，这与哮喘严重程度的任何测量指标无关。哮喘患者支气管镜检查前5天和检查后5天，特应性非哮喘患者支气管镜检查前2天和检查后1天的PC20均无明显变化。我们得出结论，对于哮喘患者，纤维支气管镜联合BAL和支气管镜活检是安全的，但对于那些呼吸道反应非常敏感的患者需要谨慎。强烈建议事先测量PC20，并在整个过程中监测血氧。
We have documented the physiologic effects of fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) and endobronchial biopsy performed under local anesthesia in 20 asthmatic subjects, 8 healthy nonatopic control subjects, and 8 atopic nonasthmatic subjects. Premedication consisted of nebulized albuterol (2.5 mg; except for the study of atopic nonasthmatic subjects), ipratropium bromide (500-mu-g), and intramuscular atropine (0.6 mg). Intravenous midazolam was given for mild sedation, and oxygen was delivered via a nasal cannula. FEV1 was measured before and after premedication, immediately postbronchoscopy, and after 2 h recovery. There was a significant fall in mean (+/- SD) FEV1 immediately postbronchoscopy in both the asthmatic (26.2 +/- 16.7%; p < 0.001) and normal (9 +/- 4.7%, p < 0.05) groups, which in the asthmatic subjects correlated inversely with the concentration of methacholine provoking a 20% fall in FEV1 (PC20) measured 5 days prebronchoscopy (r = -0.74, p < 0.001) but not with symptom scores, albuterol use, or peak expiratory flow (PEF) variation recorded during 2 wk before the investigation. There was significant arterial hemoglobin O2 desaturation during biopsy in the asthmatic subjects (median 3%, range -1 to 17% fall from baseline; p < 0.01), which was not related to any of the measured indices of asthma severity. PC20, measured 5 days before and 5 days after bronchoscopy in the asthmatic subjects and 2 days before and 1 day after bronchoscopy in the atopic nonasthmatic subjects was not significantly affected by the procedure. We conclude that fiberoptic bronchoscopy with BAL and endobronchial biopsy can be conducted safely in asthmatic subjects, but requires caution in those with very responsive airways. Prior measurement of PC20 and oximetry monitoring throughout the procedures are strongly recommended.