For patients with chronic respiratory failure whose respiratory tract and lung infections are not under control, the condition is aggravated due to large amounts of secretions blocking the airways, and the patient is unable to cough. Suctioning sputum from the nose or mouth cannot completely remove the secretions. , at this time, use a bronchoscope to aspirate the airway secretions under direct vision.
For patients with respiratory failure caused by various reasons, after tracheal intubation and artificial ventilation, due to insufficient humidification, the airway is dry, the airway secretions are thick, and the drainage is not smooth, blocking the airway and causing airway resistance. If the airway is enlarged, the effect of artificial ventilation is not good. At this time, sputum suction with fiberoptic bronchoscope should be used regularly, and management of airway humidification should be strengthened.
After lung surgery, patients may have atelectasis due to blood oozing, bleeding and accumulation of secretions in the airway that blocks the airway on the affected side or the unaffected side. If the airway secretions are not cleared in time, the condition may worsen. It worsens and directly threatens the patient's life. At this time, airway secretions should be cleared immediately with a fiberoptic bronchoscope, anti-infective treatment should be carried out, and airway management should be strengthened. BAL treats respiratory failure. Many hospitals in China have used BAL to treat respiratory failure. When conventional treatment fails, this method can be used to treat respiratory failure, and the condition can be improved. The liquid used for lavage is usually sterilized saline with antibiotics or corticosteroids that are not irritating to the airway, 30 to 50 ml each time, and then aspirated at a pressure of 13.3 to 26.6 kPa after injection, and repeated several times. The left and right sides are alternately lavaged, aspirated, and then given antibiotics. In most hospitals, after this BAL treatment, the patient's PaCO2 decreases and the patient becomes conscious.
BAL treats pulmonary infectious diseases. Severe pulmonary infections such as bronchiectasis, pulmonary suppuration, pneumonia, etc. Due to congestion, swelling and increase in purulent secretions in the bronchial mucosa, the drainage bronchus is blocked. Systemic administration of local drugs It is difficult to achieve effective drug concentration, and infections are often difficult to control. BAL treatment enables patients who are difficult to treat with traditional methods to achieve satisfactory results in most cases after treatment. Patients with severe infections should use it with caution. In terms of antibiotics, according to the drug susceptibility test report of bacterial culture, penicillin, Pioneer V, Cilixin, Fudaxin and tobramycin were selected, and an appropriate amount of dexamethasone was added. The appropriate frequency of BAL treatment is 2 to 3 times a week.
BAL treatment of pulmonary tuberculosis Domestic scholars have conducted systemic anti-tuberculosis treatment and local BAL treatment (once a week, * **4 times), after 1 month, the X-ray significant absorption is above 60, which is better than the 3-month and 6-month efficacy of oral chemotherapy treatment, and the sputum negative conversion rate has reached the effect of oral chemotherapy treatment. Among them, the effective absorption rate of the lesions in the re-treated cases was significantly higher than that of the re-treated case group who took oral chemotherapy drugs for half a year in the literature.
BAL treatment of bronchial asthma. Some people use BAL treatment with a large amount of heparin for patients with status asthmaticus for more than 1 month, and the effective rate is over 90. Some people use normal saline for BAL treatment and achieve certain results. However, many scholars believe that patients with status asthmaticus are prone to severe hypoxemia due to mucus plugs and widespread hypoventilation. Such mucus plugs can be aspirated through the bronchus with saline. Some people think that this method has certain risks, and the patients to be treated should be selected conditionally, usually in the intensive care unit, and operated by well-trained doctors.
BAL treats atelectasis. Atelectasis mostly occurs in the right middle lobe and left lingual lobe, but also in other lung lobes. For patients with atelectasis caused by right middle lobe inflammation and the time is less than 2 months, the BAL method is often effective (including children). If the period exceeds 2 months, it is only partially valid. After aspiration, inject local antibiotics (such as amikacin 0.2g or Cilixin 0.75g). For patients with inflammatory atelectasis in the right middle lobe within 2 months, BAL treatment is performed 2 times a week. ~3 times, more than 6~8 times can cure pneumoconiosis.
BAL treatment of pneumoconiosis uses whole lung lavage (WLL) in BAL to treat the acute stage of pneumoconiosis. Several hospitals in China are already doing this. Treatment research, has good successful experience.
BAL treatment of pulmonary alveolar proteinosis As early as 1963, Ramirez first performed WLL with a large amount of liquid on patients with pulmonary alveolar proteinosis. This was performed under general anesthesia and a large amount of liquid was infused. So far, no formula has been formulated. Unified standards. The patient's symptoms can be improved after WLL treatment.
BAL treats inhalation of radioactive particles and other diseases. WLL in BAL is used to clear radioactive substances in the lungs. In studies on dogs and baboons, the clearance effect of WLL was determined. Treatment of nasopharyngeal cancer
For patients with recurrence of nasopharyngeal carcinoma (NPC) after radiotherapy, under direct vision through a fiberoptic bronchoscope, the recurrent lesions on the top of the nasopharynx are treated with a fiberoptic bronchoscope injection needle into the NPC lesion. After injecting 5-Fu 2 to 3 times a week and 6 times into the vagina, the cancerous lesions on the top of the nasopharynx completely disappeared after 2 months. For new patients, this method plus radiation therapy will have better results.
Treatment of central lung cancer
For inoperable patients, 5-Fu is injected into the tumor tissue under direct vision with a bronchoscope, 2 to 3 times a week plus Radiotherapy can shrink tumors, improve airway obstruction, and improve ventilation function.
Treatment of alveolar cell carcinoma
For patients with alveolar cell carcinoma, especially those suffering from this disease in both lungs, in addition to systemic chemotherapy, high-dose 5-Fu or DDP (cis) can be used locally. Platinum) infusion therapy, especially when the patient's general condition is poor and cannot tolerate systemic chemotherapy, this method can be used. During routine fiberoptic bronchoscopy, if there is a large amount of secretions in the airway, aspiration can be performed. If necessary, a method similar to BAL is used to lavage and aspirate, and then inject anti-cancer drugs into the bronchi of each lobe of one lung, 2 to 3 times a week ( The drug is injected into both lungs in turn), and the dose of each injection is about 1 to 2 times the dose of systemic chemotherapy. After the injection, antiemetics and sedatives are used. It is often used for patients with unconsciousness, patients with burns all over the body and large areas, many critically ill medical and surgical patients, those who cannot eat and need gastrointestinal nutrition, and this method can be effective for those who fail to place a gastric tube through conventional methods. The author created this method and has applied it to more than 50 patients since 1986, all of which have been successful.