布地奈德复合异丙托溴胺雾化对气管插管全身麻醉手术患者的影响

作者:未知

  [摘要]目的 探討布地奈德复合异丙托溴胺雾化对气管插管全身麻醉手术患者的影响。方法 选取2015年1月~2018年1月我院气管插管全身麻醉60例手术患者的临床资料,依据治疗方式不同分为对照组和雾化组,每组各30例。雾化组给予布地奈德复合异丙托溴胺雾化治疗,对照组给予非雾化治疗。观察两组气管插管后25、40 min气道峰值压情况,观察两组麻醉前、麻醉苏醒后的血氧饱和度(SpO2)、氧分压(PO2)、二氧化碳分压(PCO2)情况。结果 雾化组气管插管后25、40 min气道峰值压低于对照组,差异有统计学意义(P<0.05)。两组麻醉前SpO2、PO2、PCO2比较,差异无统计学意义(P>0.05),麻醉苏醒后两组的SpO2、PO2均高于麻醉前,PCO2低于麻醉前,雾化组麻醉苏醒后SpO2、PO2均高于对照组,PCO2低于对照组,差异有统计学意义(P<0.05)。结论 布地奈德复合异丙托溴胺雾化在气管插管全身麻醉手术应用可以降低气道峰值压,提高PO2,值得临床推广应用。
  [关键词]布地奈德;异丙托溴胺;雾化;气管插管;全身麻醉
  [中图分类号] R614 [文献标识码] A [文章编号] 1674-4721(2019)5(c)-0106-03
  Effect of Budesonide combined with Ipratropium Bromide atomization on patients undergoing surgery via general anesthesia for endotracheal intubation
  TIAN Wen-hua SONG Lin-yuan LUO Ying-jia
  Department of Anesthesiology, Meizhou Hospital of Traditional Chinese Medicine, Guangdong Province, Meizhou 514000, China
  [Abstract] Objective To investigate the effect of Budesonide combined with Ipratropium Bromide on patients undergoing general anesthesia for endotracheal intubation. Methods The clinical data of 60 patients with general anesthesia for tracheal intubation from January 2015 to January 2018 in our hospital were analyzed. The patients were divided into control group and atomization group according to different treatment methods, 30 cases in each group. The atomization group was given Budesonide combined with Ipratropium Bromide anebulization therapy, the control group was given non-aerosol treatment. The peak airway pressure was observed 25 and 40 min after tracheal intubation in the two groups. The blood oxygen saturation (SpO2), oxygen partial pressure (PO2) and carbon dioxide partial pressure (PCO2) of the two groups before anesthesia and awakening after anesthesia were observed. Results The peak airway pressure was lower in the atomization group than that in the control group 25 and 40 min after tracheal intubation (P<0.05). There were no significant differences in SpO2, PO2 and PCO2 between the two groups before anesthesia (P>0.05). Awakening after anesthesia, SpO2 and PO2 in the two groups were higher than those before anesthesia, while PCO2 was lower than before anesthesia. In the atomization group, the SpO2 and PO2 levels were higher than those in the control group after anesthesia, while the PCO2 was lower than that of the control group (P<0.05). Conclusion The application of Budesonide combined with Ipratropium Bromide atomization on patients undergoing general anesthesia for tracheal intubation can reduce the peak pressure of airway and increase the partial pressure of blood oxygen, which is worthy of clinical promotion.   [Key words] Budesonide; Ipratropium Bromide; Atomization; Endotracheal intubation; General anesthesia
  慢性阻塞性肺疾病(COPD)患者由于肺功能较差、机体免疫功能低下和外界环境有害因素的共同作用,造成患者心肺疾病的发生率明显增加,该类患者进行手术,麻醉风险性明显增大[1-2]。肺功能异常变化、外科手术等刺激了患者的膈肌,进而形成高气道反应,麻醉药物发生残留,也会引起术中气道压升高,手术结束后影响气管导管的拔除,患者在拔管后形成低氧血症[3-4]。术后如果延长了拔管时间,会诱发肺部感染的发生,进而影响了患者术后的恢复效率[5-6]。本研究选择我院气管插管全身麻醉腹腔镜手术患者作为研究对象,术中使用布地奈德、异丙托溴胺雾化治疗,探讨对患者气道峰值压和血气分析结果的影响,现报道如下。
  1资料与方法
  1.1一般资料
  选择2015年1月~2018年1月我院气管插管全身麻醉腹腔镜60例手术患者的临床资料,依据治疗方式不同分为对照组和雾化组,每组各30例。对照组中,男18例,女12例;年龄66~74岁,平均(70.4±4.2)岁;手术时间2~4 h,平均(2.6±0.3)h。雾化组中,男16例,女14例;年龄65~75岁,平均(70.8±3.9)岁;手术时间2~3 h,平均(2.4±0.5)h。纳入标准:气管插管全身麻醉腹腔镜手术患者ASA分级Ⅱ~Ⅲ级,年龄65~75岁,经临床症状结合影像学检查确诊为中重度COPD患者。排除标准:既往腹部手术疾病史患者;心功能、脑、肺功能、肾功能障碍者。在患者知情同意情况下进行,本研究经医院医学伦理委员会批准。两组的一般资料比较,差异无统计学差异(P>0.05),具有可比性。
  1.2方法
  对照组气管插管后,术中不做任何雾化治疗。雾化组气管插管后30 min进行布地奈德(阿斯利康制药有限公司,批号H20140745)1 mg复合异丙托溴胺[Laboratoire Unither(法国),批号H20150173]0.5 mg雾化治疗1次。
  1.3观察指标
  ①观察两组气管插管后25、40 min气道峰值压情况。②观察两组麻醉前、麻醉苏醒后的血氧饱和度(SpO2)、氧分压(PO2)、二氧化碳分压(PCO2)情况,抽取患者动脉血,采用雅培便携式血气分析仪i-stat300G(美国雅培公司),按照说明书进行操作检测。
  1.4统计学方法
  采用SPSS 22.0统计学软件分析数据,计量资料以均数±标准差(x±s)表示,采用t检验,计数资料以百分率(%)表示,采用χ2检验,以P<0.05为差异有统计学意义。
  2结果
  2.1两组气管插管后25和40 min气道峰值压的比较
  雾化组气管插管后25 和40 min气道峰值压低于对照组,差异有统计学意义(P<0.05)(表1)。
  2.2两组麻醉前、麻醉苏醒后SpO2、PO2、PCO2的比較
  两组麻醉前SpO2、PO2、PCO2比较,差异无统计学意义(P>0.05),麻醉苏醒后两组SpO2、PO2均高于麻醉前,PCO2低于麻醉前;雾化组麻醉苏醒后SpO2、PO2均高于对照组,PCO2低于对照组,差异有统计学意义(P<0.05)(表2)。
  3讨论
  随着社会老龄化的发展,高于60岁的COPD老年患者比例明显增高,其自身手术耐受性较差,加上COPD病情的发展给临床治疗带来较大的难度[7-8]。目前COPD老年患者,国内研究多是在患者手术前后给予雾化,患者术后配合度较差,影响了雾化效果,手术过程中雾化,由于麻醉药物的作用,患者的依从性很好,并且机械通气会提高了雾化药物作用的效率,直接进入到终末气道内,雾化效果更加明显[9-10]。使用布地奈德复合异丙托溴胺雾化治疗,是治疗COPD的一种常用雾化治疗方案,但一般是复合用于术前或术后的报道,在术中雾化治疗在国内十分少见[11-12]。雾化治疗是临床上治疗COPD患者常用的方式,其机理是利用高速气体将药物变成直径很小的气溶胶颗粒,在气流的冲击下到达肺部终末气道内,结合布地奈德等药物使用,效果更加明显[13-14]。
  本研究结果显示,雾化组布地奈德复合异丙托溴胺雾化治疗,两种药物作用的机制不同,效果更加明显,同时两种药物在临床治疗COPD过程中比较常用,患者更容易接受。术中将雾化药物作用于终末气道,理论上应该获得更好的临床疗效[15-16],显著性降低气道峰值压和麻醉苏醒后低氧血症的发生比例,提高了拔管的成功率,缩短了患者治疗进程和住院时间,降低了患者经济负担和精神负担。
  本研究结果显示,雾化组气管插管后25和40 min气道峰值压均低于对照组(P<0.05),麻醉苏醒后两组的SpO2、PO2高于麻醉前,PCO2低于麻醉前;雾化组麻醉苏醒后SpO2、PO2均高于对照组,PCO2低于对照组(P<0.05),提示对COPD患者气管插管全身麻醉行腹腔镜手术,术中使用布地奈德复合异丙托溴胺雾化治疗,能显著降低患者的气道峰值压,减少麻醉苏醒后低氧血症的发生,增加术后成功拔管的概率,改善患者的预后[17-18]。
  综上所述,布地奈德复合异丙托溴胺雾化在气管插管全身麻醉手术患者应用,可以降低气道峰值压,提高血氧分压,值得临床推广应用。
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  (收稿日期:2018-10-09 本文编辑:崔建中)
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