氨溴索对微创心脏手术中患者肺损伤的保护作用  

Protective Effect of Perioperative Administration of Ambroxol on Lung Injury in Patients Underwent Minimally Invasive Cardiac Surgery

作　　者：赵晖[1] 赵子牛[1] 赵亮[1] 杨雷一[1] 程兆云[1] ZHAO Hui;ZHAO Zi-niu;ZHAO Liang;YANG Lei-yi;CHENG Zhao-yun(Department of Cardiac Surgery,The People＇s Hospital of Henan Province,Zhengzhou（450003）,Henan,China)

机构地区：[1]河南省人民医院心外科,郑州市450003

出　　处：《中国循环杂志》2018年第9期900-903,共4页Chinese Circulation Journal

摘　　要：目的:探讨氨溴索对微创心脏手术患者肺损伤的保护作用。方法:按照随机数字法将2012～2016年在我院行微创心脏手术的252例患者分为A、B、C、D四组,每组63例。A、B、C三组患者从术前1d～术后第3 d分别静脉滴注低剂量[3 mg/(kg·d)]、中剂量[9 mg/(kg·d)]、高剂量[15mg/(kg·d)]氨溴索,D组患者给予生理盐水。以术前、术后即刻、术后第1 d、2 d及3 d四组的呼吸指数(RI)、氧合指数(OI)、血清肺表面活性物质相关蛋白-A(SP-A)、血清细胞间黏附因子-1(ICAM-1)及血浆肿瘤坏死因子-α(TNF-α)水平评价肺保护作用。结果:在术后即刻,四组的RI、SP-A、ICAM-1、TNF-α均明显高于术前;A、B、C三组患者在术后第1 d、2 d和第3 d的RI、OI、SP-A、ICAM-1、TNF-α均明显低于D组的患者;C组患者在术后第2 d的RI(0.38±0.13 vs 0.49±0.11、0.45±0.12)、OI(mm Hg,1 mm Hg=0.133 k Pa;387.05±52.50 vs 431.96±58.46、433.94±57.52)、SP-A(pmol/L;71.45±10.63 vs88.45±12.19、83.32±12.45)、ICAM-1(μg/ml;71.54±12.39 vs 102.41±18.45、97.20±16.63)、TNF-α(μg/ml;54.20±15.31vs 83.45±17.52、76.19±16.24)均明显低于A、B两组患者,差异均有统计学意义(P均<0.05)。结论:氨溴索对微创心脏手术中的肺损伤具有保护作用,大剂量氨溴索的保护作用更加快速明显。Objectives： To observe the protective effect of perioperative administration of ambroxol on lung injury in patients underwent minimally invasive cardiac surgery.Methods： A total of 252 patients were randomly divided into group A, B, C and D before minimally invasive cardiac surgery in our hospital during 2012~2016（n=63 per group）. Patients received intravenous ambroxol infusion at the dosage of 3 mg/（kg·d）（low dose, group A）, 9 mg/（kg·d）（medium dose, group B） and 15 mg/（kg·d）（high dose, group C） from one day before operation to the 3 rd d after operation, respectively. Patients assigned to group D received equal volume saline infusion from one day before operation to the 3 rd d after operation. The spiro index（RI）, oxygenation index（OI）, serum pulmonary surfactant-related protein-A（SP-A）, serum intercellular adhesion molecule-1（ICAM-1） and plasma tumor necrosis factor-α（TNF-α） were used to evaluate the lung injury and determined before operation, immediately after operation, on the the 1 st, 2 nd, 3 rd day after operation. Results： Immediately after operation, the RI, SP-A, ICAM-1 and TNF-α were all significantly higher in four groups than at pre-operation levels（all P〈0.05）. The RI, OI, SP-A, ICAM-1, TNF-α levels were significantly lower in group A, B, C than in group D（all P〈0.05）. The RI（0.38±0.13 vs 0.49±0.11, 0.45±0.12）, OI（mm Hg,1 mm Hg=0.133 k Pa;387.05±52.50 vs 431.96±58.46, 433.94±57.52）, SP-A（pmol/L;71.45±10.63 vs 88.45±12.19, 83.32±12.45）, ICAM-1（μg/ml; 71.54±12.39 vs 102.41±18.45, 97.20±16.63）, TNF-α（μg/ml; 54.20±15.31 vs 83.45±17.52, 76.19±16.24） in group C was significantly lowerthan in group A and B on the 2 nd day post operation（all P〈0.05）.Conclusions：Perioperative Ambroxol administration could reduce the potential lung injury caused by minimally invasive cardiac surgery, the protective effect is more potent in patients treated with high dose ambroxol.

关 键 词：氨溴索 心脏手术 微创 肺损伤 保护作用 

分 类 号：R541[医药卫生—心血管疾病]