Necla ÖZDEMİR, Sinan ERGİNEL, Mustafa KOLSUZ, Sevda MUTLU, Osman ELBEK, Arzu YURDASİPER, Emel HARMANCI

Bronkoalveoler lavajın astmalılar ve interstisyel akciğer hastalarında güvenilirliği

Amaç: Bronkoalveoler lavaj (BAL)’ın astmalı ve interstisyel akciğer hastalıklı (İAH) hastalardaki solunum fonksiyon testleri (SFT) ve arter kan gazları (AKG) üzerine etkilerini saptayarak, bu yöntemin her iki hasta grubunda uygulanmasının güvenilirliğini saptamak. Metod: Çalışmamızda astmalı 9 hasta ile interstisyel akciğer hastalığı (İAH) olan 10 hastada işlemden hemen önce, işlemden sonra ilk yarım saatte ve işlemden sonra ikinci saatte solunum fonksiyon testleri ve arter kan gazları tespit edildi. Hastalara işlem sırasında ve işlemden sonra 1-2 L/dk oksijen nazal kanülle verildi ve astmalı hastalara işlemden önce kısa etkili b2 agonist 2 puff (200 µg) inhale ettirildi. Sonuçlar: Astmalılarda işlemden hemen sonra bakılan FEV1 ve FVC değeri işlemden öncekine göre anlamlı düşüş gösterdi (p< 0.05 ve p< 0.01). İkinci saatte bakılan FEV1 ve FVC bir miktar düzelme gösterdiyse de bu anlamlı değildi (p> 0.05). İAH olanlarda FEV1 ve FVC BAL’dan hemen sonra ve 2. saatte anlamlı düşüşler gösterdi (p< 0.05). Arteriyel oksijen basıncı (PaO2), astmalılarda (p< 0.01) ve İAH olanlarda (p< 0.05) işlem sonrası 30. dakikada önemli düşüşler gösterdi. Ancak her iki grupta, 2. saat sonunda işlemden önceki değerlerden farklı değildi (p> 0.05). Oksijen saturasyonu İAH’li olgularda değişiklik göstermezken, astmalılarda işlemden hemen sonra görülen ve 2. saatte düzelen bir düşme gösterdi (p< 0.05). Sonuç: Astmalı olgular, BAL’ın solunum fonksiyonları ve kan gazları üzerindeki olumsuz etkilerine İAH’li olgulardan daha duyarlı olmaktadırlar. Bu hastaların BAL sonrası yakından takipleri faydalı olacaktır.

The safety of bronchoalveolar lavage in asthmatic and interstitial lung disease patients

Aims: To evaluate the reliability of bronchoalveoler lavage (BAL) in the patients with asthma and with interstitial lung disease (ILD) determining its effects on pulmonary function tests (PFT) and arterial blood gases (ABG). Method: PFT and ABG were determined before, within 30 minutes and 2 hours after BAL in 9 patients with asthma and 10 patients with ILD. All patients were given 2 L/min O2 with nasal cannulae during and after the procedure and asthmatics were given 200 µg inhaler b2 agonist before BAL. Results: FEV1 and FVC values significantly decreased in the asthmatics just after BAL (p< 0.05 and p< 0.01). FEV1 and FVC values improved a little at the 2th hour but it is not significant (p> 0.05). In ILD patients, FEV1 and FVC values decreased significantly just after and 2 hours after BAL (p< 0.05). Arterial oxygene pressure (PaO2) was decreased significantly in the asthmatics (p< 0.01) and in ILD patients (p< 0.05) just after BAL. But in both groups it was not different at the 2th hour than the initial value (p> 0.05). While arterial O2 saturation had not been changed in ILD, there was a decrease just after BAL with the improvement at the 2th hour in the asthmatics (p< 0.05). Conclusion: Asthmatics patients are more susceptible to the side effects of BAL than the patients with ILD. It is useful to follow up these patients closely after BAL.

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