牛肺表面活性剂在术后顽固性肺不张患者中的应用  

Combined inflating lung and insuffiating calf pulmonary surfactant under general anesthesia in the treatment of postoperative intractable atelectasis

作　　者：陆雅萍 胡奕[2] 施谷平[2] 姚明 黄冰 周煦燕 孙建良 杜建龙 谢郭豪[4] 方向明[4] 

机构地区：[1]嘉兴市第一医院麻醉科,浙江嘉兴314000 [2]嘉兴市第一医院胸外科,浙江嘉兴314000 [3]桐乡第一医院麻醉科 [4]浙江大学医学院附属第一医院麻醉科

出　　处：《中华医学杂志》2013年第23期1838-1840,共3页National Medical Journal of China

基　　金：浙江省医药卫生科技计划项目A类（2011KYA154）;浙江省中西医结合疼痛医学重点学科建设计划（2012-XK-A31）

摘　　要：目的探讨全身麻醉下控压膨肺复合靶点吹入牛肺表面活性剂治疗术后顽固性肺不张的临床效果与安全性。方法嘉兴市第一医院外科2006年8月至2013年1月15例术后顽固性肺不张经1次控压膨肺治疗未能复张患者，行控压膨肺复合靶点吹入牛肺表面活性剂治疗，由胸部听诊及术后第1、5天胸部CT评判疗效，记录膨肺治疗过程中气道吹张压力及治疗前、中、后患者平均动脉压（MAP）、心率、呼吸频率（RR）和脉搏氧饱和度（SpO2）的变化，并监测治疗前后动脉血气。结果术后第1天胸部CT显示，12例患者（80．0％）萎陷肺泡已全部复张，3例患者（20．0％）萎陷肺泡复张不完全；术后第5天胸部影像学检查14例患者（93．3％）肺泡全部复张并维持于膨胀状态，1例患者（6．7％）萎陷肺泡仍复张不完全。治疗期间患者生命体征稳定，无插管损伤及其他相关并发症发生，血气分析PaO2在治疗结束、术后第1、3、5、7天与治疗前比较，差异均有统计学意义（均P〈0．05），PaCO2、pH的变化治疗前后差异无统计学意义（P〉0．05）。结论控压膨肺复合靶点吹入1mg／kg牛肺表面活性剂能安全有效地治疗术后顽固性肺不张，但有待于大样本多中心的临床验证。Objective To explore the efficacy and safety of combined inflating lung and insufflating calf pulmonary surfactant under general anesthesia for treating postoperative intractable atelectasis. Methods From August 2006 to January 2013, 15 patients with obstinate postoperative atelectasis receiving pressure control lung expansion were enrolled. The bronchial cannula was intubated into the affected side to assist the expanding of the lung, and the calf pulmonary surfactant was insufflated selectively. The chest auscultation and computed tomography （CT） scan was performed at 1 d and 5 d after the procedure respectively, to evaluation the effect. The airway pressure, mean arterial pressure （MAP）, heart rate （HR）, respiratory rate （RR） and oxygen saturation （SpO2 ） were recorded before the treatment, during the treatment and after the treatment. Monitoring arterial blood gas before and after treatment. Results After the expansion of the lung and iusufflation of calf pulmonary surfactants, the ieonographic scan showed that collapsed alveolar was reinflated in 12 （80. 0% ） patients at 1 d after the treatment and in 14 patients（93.3% ） at 5 d after the procedure. There were not notable vital sign change and complications during the treatment. At after the treatment, 1,3,5 and 7 d after the treatment, PaO2 was higher （ P 〈 0. 05 ） , and there were not significantly difference in the PaCO2 and pH （ P 〉 0.05 ）. Conclusion Combined pressure control lung expansion with selectively insufflating calf pulmonary surfactant under general anesthesia may be an effective therapy for postoperative intractable atelectasis.

关 键 词：控压膨肺 全身麻醉 牛肺表面活性剂 顽固性肺不张 

分 类 号：R6[医药卫生—外科学]