氨溴索对体外循环下心脏手术患者围术期的肺、肾功能影响  

Influence of ambroxol on the perioperative lung and kidney function of patients undergoing cardiac surgery under cardiopulm onary bypass

作　　者：吕定量[1] 万海军[1] 

机构地区：[1]浙江省衢州市人民医院胸外科,324000

出　　处：《心电与循环》2016年第4期261-265,共5页Journal of Electrocardiology and Circulation

摘　　要：目的探讨氨溴索对体外循环下心脏手术患者围术期的肺、肾功能影响。方法 90例拟行体外循环下心脏手术的患者,随机分为观察组和对照组,每组各45例。观察组患者于术前当天至术后3d给予盐酸氨溴索静脉滴注（60mg,3次/d）,对照组给予等剂量0.9%氯化钠溶液。分别在术前、手术结束时、术后1、3、5天测定血清细胞间黏附分子-1（CAM-1）、血浆肿瘤坏死因-α（TNF-α）;同时,测定尿微量白蛋白（Alb）、N-乙酰-β-D-氨基葡萄糖苷酶（NAG）及Cr。测定体外循环前、体外循环结束时、结束后2h、6h及12h的呼吸指数（RI）和氧合指数（OI）。结果两组患者血清CAM-1及TNF-α在术后均明显升高,在T2达到高峰后逐渐降低,但观察组CAM-1、TNF-α在T1-T4均低于对照组（均P〈0.05）。两组患者体外循环后2h、6h及12h的RI、OI均高于体外循环前,观察组的体外循环后2h、6h及12h的RI、OI均低于对照组,差异均有统计学意义（均P〈0.05）。Alb/Cr、NAG/Cr观察组术后3d、对照组术后4d均高于术前,差异有统计学意义（均P〈0.05）,对照组术后Alb/Cr、NAG/Cr均高于术前,差异有统计学意义（均P〈0.05）。观察组术后Alb/Cr、NAG/Cr均低于对照组,差异均有统计学意义（均P〈0.05）。结论氨溴索能减轻与体外循环手术相关的炎症反应及肺肾损害。Objective To explore the influence of ambroxol on perioperative lung and kidney function of patients undergoing cardiac surgery under cardiopulmonary bypass（CPB）. Methods 90 patients undergoing heart surgery under CPB were randomly divided into ambroxol group （45 cases）, received ambroxol injection（60 mg, q8h） at the day before and three days after operation, and control group （45 cases）, received 0.9% saline instead. Serum intercellular adhesion molecule - 1（ICAM -1） and plasma tumor necrosis factor-alpha （TNF- α ） were measured just before, at the end of, at the first, third and fifth day after operation. Urine microalbumin, n-acetyl-beta-D-amino glycosidase enzymes （NAG） and creatinine（Cr） were measured at the same time. Respiratory index （RI） and oxygenation index （OI） were measured before, at the end of, 2h, 6h and 12h after CPB. Results ICAM-1 and TNF-a increased obviously and achieved peak level at first day after operation and then decreased gradually in both groups, which were significantly lower in ambroxol group than control group （all P〈0.05）. RI and OI increased after CPB and were significantly lower in ambroxol group than control group （all P〈0.05）. Microalbumin / Cr and NAG / Cr were significantly higher at 3 days in ambroxol group and 4 days in control group after operation than before operation （all P〈0.05）, and significantly lower in ambroxol group than control group after operation （all P〈0.05）. Conclusion Ambroxol can reduce inflammation reaction and damage of lungs and kidneys related to operation under CPB.

关 键 词：氨溴索 体外循环 炎症反应 肾功能 肺功能 

分 类 号：R654.2[医药卫生—外科学]