Source: Junction News Client
Intersection News Recently, the Respiratory and Critical Care Center of Nantong Sixth Hospital (Shanghai University Affiliated Hospital) quickly washed "milk lungs" for a patient with a rare disease - alveolar protein deposition, suffering from "cough and chest tightness" but could not be cured for a long time through alveolar lavage. After the operation, the patient sighed and resumed his previous free and free breathing, "Refreshed, this feeling is wonderful!" ”
Aunt Bian, 59 years old this year, was diagnosed with "lung infection" in a local hospital for "coughing up phlegm and with chest tightness for half a month", and after various treatments, there was still no improvement. For further diagnosis and treatment, he came to the Respiratory and Critical Care Center of Nantong Sixth Hospital for treatment. Zhao Huan, director of the Respiratory and Critical Care Medical Center, found that her lungs had extensive interstitial changes in her lungs after a CT examination of Aunt Bian's chest, and the image characteristics were more in line with a rare disease - alveolar proteinosis, commonly known as "milk lung". To further confirm the diagnosis, Zhao Huan recommended that he undergo a lung aspiration biopsy specimen examination, which showed that the cavity was filled with eosinophilic granular protein-like substance, which was consistent with alveolar protein deposition after special chromosomal examination. Through multidisciplinary joint diagnosis and two alveolar lavages, Aunt Bian was happily discharged from the hospital.
Pulmonary proteinosis, the incidence is only about 3 parts per million. 7
Pulmonary proteinosis is a rare lung disease of unknown cause with an incidence of about 0 parts per million. 36－3． 7, characterized by alveoli and terminal respiratory bronchiar sedimentation of a large number of surfactants and lipids.
Most patients with this disease have an insidious onset, the common symptoms are dyspnea (progressive shortness of breath) with cough, occasionally coughing up sputum, clinically easy to misdiagnosis, if not actively treated, the patient will eventually cause a large number of alveolar deposits to cause impaired lung ventilation and ventilation function, and even severe respiratory failure. At present, the most clear and effective treatment method in the clinic is total lung lavage (WLL), that is, the removal of sedimentary proteins and lipids in the alveoli by lavage.
Due to the limited treatment of this disease, in order to help Aunt Bian alleviate cough and shortness of breath symptoms and improve lung function as soon as possible, Zhao Huan joined hands with multidisciplinary physicians - Du Wulin, chief of the medical department, Shi Guanglin, deputy director of the Respiratory and Critical Care Center, Yin Zhongbo, director of the Pathology Department, Zhang Haiyun, director of the Laboratory Department, Chen Yonghong, director of the Department of Anesthesiology, Huang Shuai of the Rehabilitation Department, Lu Pei of the Department of Pharmacy, and Wei Yulin, Mao Xiaojuan, Huang Zhiyong, doctors of the Respiratory and Critical Care Center, to conduct MDT discussions. After a thorough assessment of the patient's general condition and lung function status, it was decided to perform left lung total lung lavage.
Two lung intervention lavages to wash out 33,000 ml of "milk"
At 9:00 a.m. on April 23, under the leadership of Zhao Huan, a double-lumen tracheal intubation and single-lung ventilation under general anesthesia were performed for Aunt Bian.
During the operation, Chen Yonghong accurately intubated the trachea, zhao Huan used ultra-fine bronchoscopy to repeatedly confirm the position of the bilateral tracheal catheter and balloon, because to ensure that the bilateral lung is completely isolated, the catheter position and whether the balloon can seal the bronchi is the key to the success of the operation, at the same time, unilateral ventilation of the right lung, with 37 °C normal salt water subfusion into the bronchi of each lobe of the left lung for lavage, a total of 15,000ml of lavage, lavage liquid from the initial meat washing water sample to milky, until clarified. Nurse Xie Xiaomin and others accurately grasp the total amount of lavage liquid, the recovery rate of lavage, and the time of lavage.
The operation lasted 3.5 hours and ended at 12:30. During the operation, the physicians worked closely together to closely observe the patient's vital signs, whether there were complications such as arrhythmias, pulmonary edema, laryngeal bronchospasm, contralateral lung drowning, etc., and calmly responded to various emergencies. After the operation, the patient returned to the respiratory and critical care unit and continued to be treated with ECG monitoring and anti-infection.
On 26 April, another right lung total lung lavage was performed, and 18,000 ml was lavageed. After two full lung lavages, Aunt Bian's cough and shortness of breath symptoms improved significantly, and the re-examination of chest CT showed that the ground glass shadow of both lungs was significantly reduced, and the blood oxygen saturation increased, and she was successfully discharged from the hospital.
The success of the operation is inseparable from the trust of the patient
Total lung lavage is a technique that improves patient respiratory function by removing alveolar surface deposits by lavage, and this technique is used to treat alveolar protein deposition, pneumoconiosis and other diseases. Due to complications such as drowning, pulmonary edema, cardiac insufficiency, arrhythmia, pneumothorax, hypokalemia and other complications during and after surgery, the technical level of operators and anesthesiologists is high.
This operation is the first alveolar lavage surgery of Nantong Sixth Hospital (Shanghai University Affiliated Hospital), and it is also another technological breakthrough in the field of respiratory endoscopic intervention in the respiratory and critical care medical center of the sixth hospital. The success of the operation is inseparable from the patient's trust in the six hospitals and all the medical staff of the respiratory and critical care center!
Zhao Huan said that trust is an interaction, as Professor Lang Jinghe wrote in the "Apocalypse of Medical Practice": even the youngest doctor is an elder in the eyes of the patient, and he is willing to pour everything out to you; the incompetent doctor is also a sage in the eyes of the patient, and he thinks that you can solve everything. That's where the doctor's dilemma lies. In the face of patient dependence and trust, the doctor's sense of seriousness and responsibility is particularly strong.
Correspondent Zhang Lingli Cao Yu
Edit: Xu Chao
This article is from the Meeting Point News Client and represents the author's views only. The National Party Media Information Public Platform provides information release and dissemination services.