富马酸氯马斯汀联合肺保护性通气对胃肠急危重症开腹手术患者的肺保护作用  

Lung protective effects of clemastine fumarate combined with lung protective ventilation on critical patients underwent gastrointestinal surgery

作　　者：何云 柯剑娟[1] HE Yun;KE Jianjuan(Department of Anesthesiology,Central South Hospital,Wuhan University,Wuhan,Hubei 430071,China)

机构地区：[1]武汉大学中南医院麻醉科,430071

出　　处：《重庆医学》2020年第16期2744-2747,共4页Chongqing medicine

摘　　要：目的探讨富马酸氯马斯汀联合肺保护性通气(LPVS)对胃肠急危重症开腹手术患者的肺保护作用。方法选取该院2018年7月至2019年5月行胃肠开腹手术治疗的72例急危重症患者,分为对照组(n=35)和观察组(n=37),对照组仅采用LPVS,观察组于全身麻醉诱导前肌肉注射富马酸氯马斯汀注射液2 mg并联合LPVS。检测两组血流动力学、呼吸力学相关指标、动脉血气指标、机械通气时间、ICU入住时间、术后肺部相关并发症、肺外重要脏器并发症及病死率。结果两组一般情况包括性别、年龄、术前心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、动脉血氧分压(PaO2)、急性生理学及慢性健康状况评分Ⅱ得分和手术时间比较,差异无统计学意义(P>0.05);观察组术毕HR和CVP均低于对照组,而MAP、呼吸系统顺应性(Crs)、pH、PaO2及氧合指数均高于对照组(P<0.05),吸气峰值(PIP)、气道阻力(Raw)、平均气道压(MPaw)均低于对照组,差异有统计学意义(P<0.05);观察组机械通气时间和ICU入住时间、术后急性肺损伤(ALI)、急性呼吸窘迫综合征(ARDS)及多器官功能衰竭综合征(MODS)的发生率低于对照组,差异有统计学意义(P<0.05),但两组病死率比较,差异无统计学意义(P>0.05)。结论富马酸氯马斯汀联合LPVS能改善胃肠急危重症开腹手术患者的呼吸力学及氧合功能,稳定血流动力学。Objective To investigate the lung protective effect of clemastine fumarate combined with lung protective ventilation(LPVS)on critical patients underwent gastrointestinal surgery.Methods A total of 72 patients with acute and critical patients who underwent gastrointestinal laparotomy from July 2018 to May 2019 were selected,and divided into the control group(n=35)and the observation group(n=37).The control group only recived LPVS,while the observation group was intramuscularly injected 2 mg clemastine fumarate before induction of general anesthesia,then received LPVS.Hemodynamics,respiratory mechanics related indicators,arterial blood gas index,mechanical ventilation time,ICU admission time,complications of important extra-pulmonary organs and mortality were detected.Results There were no statistically significant differences between the two groups in general conditions,including gender,age,preoperative heart rate(HR),average arterial pressure(MAP),central venous pressure(CVP),arterial oxygen partial pressure(PaO2),acute physiological and chronic health condition scoreⅡand operation time(P>0.05).After surgery,HR and CVP in the observation group were lower than those in the control group,MAP,respiratory compliance(Crs),pH,PaO2 and oxygenation index were higher than those in the control group(P<0.05).The inspiratory peak(PIP),airway resistance(Raw)and average airway pressure(MPaw)were lower than those in the control group(P<0.05).The mechanical ventilation time and ICU admission time,the incidence of acute lung injury,acute respiratory distress syndrome and multiple organ dysfunction syndrome(MODS)in the observation group were lower than those in the control group(P<0.05).The mortality between the two groupshad no significant difference(P>0.05).Conclusion Clemastine fumarate combined with LPVS can improve respiratory mechanics,oxygenation function and stabilize hemodynamics in critical patients with gastrointestinal surgery.

关 键 词：富马酸氯马斯汀 肺通气 危重病人医疗 消化系统外科手术 呼吸力学 血流动力学 

分 类 号：R604[医药卫生—外科学]