沐舒坦不同给药途径对体外循环心脏手术患者肺保护效果的对照研究  

作　　者：金艳[1] 王蕾[1] 赵璧君[1] 邓超[1] 

机构地区：[1]第四军医大学西京医院心血管外科,710032

出　　处：《当代医学》2012年第7期11-13,共3页Contemporary Medicine

摘　　要：目的探讨沐舒坦不同给药途径对体外循环心脏手术患者肺保护效果的差异。方法选取2010年5月～2011年6月间于心血管外科行体外循环心脏手术的患者共148例,随机分为4组:对照组、静滴组、雾化组、静滴及雾化联合组,每组均为37例。按体外循环结束、术后1小时、术后24小时3个时间点记录患者如下指标:肺静态顺应性(Cstat)、平台压(Plat)、气道阻力R、血气分析结果;记录患者术前、术后24小时肿瘤坏死因子(α-TNF)、白介素-6(IL-6)等细胞因子的变化;同时对比两组机械通气时间、ICU时间等指标上的差异。结果各组间患者术前一般资料、CPB时间及阻闭时间无明显差异。以术前患者各呼吸力学指标为基础值,各组呼吸力学指标在CPB结束即出现明显改变,各组Cstat均有所下降,Plat、R均有所升高,其中,各实验组Cstat降低幅度及Plat、R升高幅度均低于对照组,且以静脉及雾化联合给药组更为明显(P<0.05);术后实验组与对照组对比α-TNF、IL-6明显降低,静脉及雾化联合组细胞因子降低更为显著(P<0.05)。静滴及雾化联合组机械通气时间及ICU时间明显短于对照组及其他实验组(P<0.05)。结论研究结果提示沐舒坦经过静滴及雾化联合给药对CPB术后患者呼吸功能有较好的保护作用,是最佳的给药方式。Objective To study whether the different route of administrations could affect the protective effect on lung functions with ambroxol in patients with cardiopulmonary bypass. Methods 148 patients were randomly divided into four groups. They are control group, intravenous infusion group, atomizing inhalation group, and intravenous infusion combine with atomizing inhalation group. Mechanical ventilation parameters were evaluated at end of the CPB, 1 hours and 24 hours, cytokines were evaluated before induction of anesthesia, and 24 hours after CPB. Results After the CPB, Cstat value in all groups were lower than the value of preoperative, and Plat, R value were higher than the value of preoperative. All the treating groups were less decrease in Cstat value and less increase in Plat, R value than the control group, especially in the intravenous infusion combine with atomizing inhalation group （P〈0.05）. α-TNF and IL-6 were lower in all groups after the CPB, and the intravenous infusion combine with atomizing inhalation group was the lowest （P〈0.05）.There was no significant difference in CPB time in those groups, but mechanical ventilation time and ICU time were significantly shorter than control group （P〈0.05）. Conclusion These findings indicate that the way of the administrations could affect the protective effect on lung functions with ambroxol in patients with cardiopulmonary bypass, and the best way of administration is intravenous infusion combine with atomizing inhalation.

关 键 词：体外循环 心脏手术 肺损伤 沐舒坦 

分 类 号：R654.1[医药卫生—外科学]