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    长海医院呼吸内科

    黄怡

    定义

    ? 支气管肺泡灌洗

    (Bronchoalveolar Lavage，BAL)

    利用纤维支气管镜向支气管肺泡内注入生理盐水

    并随即抽吸，收集肺泡表面衬液，检查其细胞成

    份和可溶性物质的一种方法。主要用于对有关疾

    病的临床诊断以及研究肺部疾病的病因、发病机

    制、评价疗效和预后等。

    发展简史

    ? 1828年Green开始探索气管插管的可能性

    并注入液体进入支气管；

    ? 1904年Chevalier Jackson在支气管镜远端

    装置光源和安置吸引管，促进了硬质支气

    管镜的发展；

    发展简史

    ? 1964年Shiigaeo Lkeda发明纤维支气管镜

    并使用于临床为BAL打下基础；

    ? 1974年Reynolds与Newball等发展了支气管

    肺泡灌洗技术(治疗肺泡蛋白沉积症)。2

    临床分类

    ? 支气管肺泡灌洗检查术 (BAL)

    ? 治疗性支气管肺泡灌洗术

    ? 全肺灌洗(whole lung lavage)

    ? 大容量全肺灌洗(massive pulmonary lavage)

    ? 低容量全肺灌洗(Volume controlled pulmonary lavage)

    ? 肺叶支气管肺泡灌洗(Lobulous bronchoalveolar

    lavage,LBAL)

    适应证--肺泡蛋白沉积症、矽肺、尘肺、肺泡微石症、哮喘持

    续状态等的治疗。

    支气管肺泡灌洗

    (Bronchoalveolar lavage)与

    支气管冲洗

    (Bronchial washings )区别

    ?Procedure commonly

    includes bronchial washings

    for cytology, fungi, and acid-

    fast bacilli

    Procedure Name Bronchial Washings

    ? Technique the bronchoscope is

    passed in the usual manner.

    Isotonic saline is instilled through

    the inner channel of the

    bronchoscope. Fluid is aspirated

    into a trap connected in-line to the

    suction tubing.

    Procedure Name Bronchial Washings

    ? Usually 2-5 ml aliquots of fluid

    are instilled with each washing

    and approximately one-fourth to

    one-half of this volume is

    recovered.

    Procedure Name Bronchial Washings3

    ? For endoscopically visible lesions, the fluid is

    washed directly over the area in question. For

    lesions which are not visible, the

    bronchoscope is wedged in the respective

    segment and washings are aspirated. For

    tumors which are diagnosed on sputum

    cytology, but remain radiographically and

    endobronchially invisible, washings of each

    segment can be performed for localization of

    the tumor.

    Procedure Name Bronchial Washings

    ? Specimen 5-30 ml aspirated 0.9%

    normal saline along with bronchial

    secretions

    Procedure Name Bronchial Washings

    BAL的应用范围和适应征

    一、肺部感染的病原体检查 ......