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Pneumoconiosis is the most serious occupational disease that harms the health of coal miners. Since the founding of the People's Republic of China, the total number of pneumoconiosis in mines alone has reached 580,000, and the number of suspected pneumoconiosis has reached 565,438+10,000, totaling over 65,438+10,000. At present, the prevention and treatment of pneumoconiosis is still a big problem. The scientific research achievement of "Clinical Study on Treating Coal Workers' Pneumoconiosis by Simultaneous Large-capacity Lung Lavage" in Beidaihe Sanatorium of China Coal Mine Workers has been appraised by experts. The lung lavage has treated more than 2,400 people, and the longest time after treatment is 12 years, which has achieved good results.
This achievement won the second prize of the 11th Science and Technology Progress Award of the Ministry of Coal 1993 and the third prize of the National Science and Technology Progress Award 1995. In the past ten years, lung lavage has been steadily explored in the direction of high, difficult and deep. Six patients with pneumoconiosis in Russia, Vietnam/KLOC-0 received lung lavage treatment, all of which achieved satisfactory results, and no accident occurred. But many pneumoconiosis patients often encounter the following problems:
Can pneumoconiosis be treated? This is an important issue in the academic circles and the prevention and treatment of pneumoconiosis, which has been debated for a long time. As we all know, pneumoconiosis is caused by long-term inhalation of a large number of free silica, coal dust or other powders to form alveolitis, which leads to the formation of silica nodules with collagen fibers as the main component in the lungs, diffuse progressive interstitial fibrosis, and finally leads to cardiopulmonary insufficiency and respiratory failure, and the patients are in great pain. Some scholars believe that pneumoconiosis cannot be treated because pulmonary fibrosis is an irreversible pathological manifestation.
So far, there is no drug in China that can remove the dust from the lungs or solve the problem of pulmonary fibrosis. At present, comprehensive treatment is generally used, including patients getting rid of dust in time, regular follow-up, strengthening nutrition, doing physical exercise and enhancing patients' optimism. Clinically, it mainly treats its complications, such as tuberculosis, pulmonary infection, emphysema, pneumothorax, pulmonary heart disease and so on, as well as symptomatic treatment.
We advocate that comprehensive treatment with large-capacity whole lung lavage can effectively alleviate the pain of pneumoconiosis patients, improve their quality of life, delay the development of lesions and prolong their lives. After Professor Mason of the United States first reported 1 case of large-capacity lung lavage to treat mixed pneumoconiosis in stages in 1982, this work was carried out in China in 1986, and large-capacity lung lavage was realized in Beidaihe Coal Mine Workers' Sanatorium in19/year. This therapy can remove a lot of dust, dust-swallowing macrophages, fibrosis factors and inflammatory factors, which provides a new way for pneumoconiosis treatment and secondary prevention.
Why can massive lung lavage play the role of treatment and secondary prevention? Lung lavage is a therapeutic measure for pneumoconiosis patients with dust and macrophage alveolitis. Patients inhale a lot of dust in the workplace, some of which are excreted by coughing and expectoration, but some of them remain in bronchioles and alveoli for a long time and are constantly swallowed up by alveolar macrophages. This part of dust is called respiratory dust, and it and dust-swallowing macrophages are the main pathogenic factors of pneumoconiosis.
Studies have shown that once pneumoconiosis is formed, the residual dust in the lungs will continue to interact with alveolar macrophages, which is the main reason why pneumoconiosis continues to develop and upgrade even if it is out of the dust working environment. If early lung lavage can expel coal dust deposited in the alveoli of patients and a large number of dust cells that can secrete into fibrous media, it can not only obviously improve symptoms, but also help to inhibit the progress of the disease and delay the escalation of the disease. Lung lavage can prevent or delay the onset of dust-exposed workers and suspected pneumoconiosis workers whose chest radiographs have not changed. Lung lavage is a kind of etiological treatment, and it can also play the role of secondary prevention (primary prevention refers to preventing dust in the environment from entering the lungs, and secondary prevention refers to removing dust that has entered the lungs but is not wrapped to prevent illness).
Which patients are suitable for large-volume lung lavage? According to the experience, the main indications of lung lavage are: (1) pneumoconiosis in all stages, including silicosis, coal worker's pneumoconiosis, coal worker's pneumoconiosis, cement pneumoconiosis, welder's pneumoconiosis and other inorganic pneumoconiosis, O+, I, II and III are not complicated with tuberculosis, pulmonary bullae, severe emphysema, tracheobronchial malformation, serious heart disease, hypertension and hematological diseases. (2) Severe or refractory lower respiratory tract sensation, such as refractory asthmatic bronchitis and bronchiectasis. (3) Pulmonary alveolar proteinosis. (4) Current situation of chronic asthma. (5) Remove inhaled foreign bodies.
12 years, China coal mine beidaihe sanatorium has treated 2400 patients with satisfactory results. Symptoms have improved. After lung lavage, patients can feel smooth breathing, chest tightness, chest pain and shortness of breath improve or disappear, and the curative effect is consolidated after three years of follow-up Physical fitness and physical recovery. 45 cases were followed up for 3 years. The physical strength of 32 cases increased significantly (7 1. 1%), and the average weight increased by 2. 18 kg. The number of people with colds and upper respiratory tract infections decreased by 9 1. 1%. Total dust removal: 3000-5000 mg per lung, including 70-200 mg of free silica. Remove about 108 dust swallowing macrophages. Pulmonary function is mainly in small airway resistance, diffusion function is obviously improved, and arterial oxygen partial pressure is improved to some extent. After 7-8 years of follow-up, the progress and obvious progress rate of lesions in the treatment group were significantly lower than those in the control group, and the stability rate in the treatment group was significantly higher than that in the control group, suggesting that lung lavage can really delay the escalation of pneumoconiosis.
Patient Chen Lihao, male, 70 years old, tunneling and coal mining worker in Fengfeng mining area of Hebei Province, coal worker's pneumoconiosis stage II. The patient had chest tightness, shortness of breath and general weakness before operation. During the period 199 1 in our hospital, both lungs were perfused synchronously with large volume, and the symptoms of chest tightness, shortness of breath and general fatigue disappeared after operation. After two years, the appetite, appetite and physical strength were significantly improved compared with those before lavage, and they were engaged in manual labor. After reexamination in 2004 (after 12), I was in good health and physical strength, and I could freely lift water from a well several meters deep with buckets.
Up to now, more than 4000 cases have been treated by large-capacity lung lavage in more than 30 medical units across the country, and no deaths have been reported. Good clinical effect and safety. There may be some complications during and after operation, and the incidence rate is less than 3%. With the proficiency and perfection of technology, especially the application of fiberoptic bronchoscope to check the alignment of tracheal catheter, the accuracy of its positioning is ensured, and the residual fluid in the lung after lavage is reduced to the utmost extent. At present, there are few complications. Animal experiments show that the alveolar basement membrane can appear slightly reversible transient congestion changes, and return to normal within 24-48 hours. Practice has proved that this is a safe and effective new technology.
The basic method of large-capacity whole lung lavage is to put a double-lumen catheter in the trachea and bronchus of the patient under intravenous anesthesia, one side of the lung is ventilated with pure oxygen, and the other side is repeatedly perfused with lung lavage fluid. Generally, each time is 1000- 1500ml, * * lavage 10- 14 times, and each lung needs 1 .2-2.0l, lasting about1hour, until the lavage and recovery industry.
Lung lavage can remove the residual dust and dust cells in the lung, and can contain and delay the escalation of the disease, but it can not solve pulmonary interstitial fibrosis, nor can lung lavage degrade pneumoconiosis. Pneumoconiosis patients should not be exposed to dust in principle after lung lavage. If it comes into contact with dust again, it should be douched again after 3-5 years. In order to consolidate the curative effect, reduce irritation and enhance immunity, alcohol should be banned. Lung lavage for a week should pay attention to rest, keep warm and prevent colds. Take a chest X-ray and lung function review in the local area for six months to one year.
The China Coal Mine Workers' Pneumoconiosis Treatment Foundation, established under the care of the Premier, is implementing the pneumoconiosis rehabilitation project, carrying out comprehensive treatment of pneumoconiosis with lung lavage as the main method, and organizing the popularization of new technologies. Since its establishment in June, 2003, 5438+ 10, by the end of August, 2006, the Foundation has funded more than 2,000 pneumoconiosis patients for lung lavage and rehabilitation treatment. At present, training has been completed for Jinmei Group, Pingmei Group, Kailuan Group General Hospital, Fujian Coal Mine Central Hospital, Tongchuan Mining Bureau General Hospital and other units. It is planned to popularize and apply the lung lavage treatment technology at the same time in 20 hospitals nationwide 15-20 based on the pneumoconiosis rehabilitation center of the State Administration of Coal Mine Safety, and treat the total number of people 1 10,000 people every year.
Solving the treatment cost of pneumoconiosis patients is another major task. First of all, enterprises should take responsibility. In order to establish a long-term mechanism, it is suggested that the labor and social security department should include lung lavage and other methods to treat pneumoconiosis in the catalogue of work-related injury insurance diagnosis and treatment items. Jilin Province took the lead in carrying out this work, including lung lavage treatment of pneumoconiosis into the diagnosis and treatment project of industrial injury insurance, and the rehabilitation center of pneumoconiosis of the State Administration of Coal Mine Safety into designated hospitals.