静脉输注氨茶碱减轻老年全髋关节置换术患者术后肺部并发症:一项前瞻性双盲随机对照研究  

Intravenous infusion of aminophylline alleviates postoperative pulmonary complications in elderly patients under total hip arthroplasty:a prospective,double-blind randomized controlled trial

作　　者：刘亮 徐雨晴 武岩 杨玉萍 王姝婷 刘苏 LIU Liang;XU Yuqing;WU Yan;YANG Yuping;WANG Shuting;LIU Su(Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China;Department of Anesthesiology,Tongshan District People′s Hospital of Xuzhou,Xuzhou,Jiangsu 221000)

机构地区：[1]徐州医科大学附属医院麻醉科,江苏徐州221002 [2]徐州市铜山区人民医院麻醉科,江苏徐州221000

出　　处：《徐州医科大学学报》2022年第6期396-401,共6页Journal of Xuzhou Medical University

基　　金：江苏省高等学校自然科学研究重大项目(17KJA3320006)。

摘　　要：目的探讨围术期静脉输注氨茶碱对老年全髋关节置换术患者肺功能和术后肺部并发症的影响。方法选择279例择期行全麻下全髋关节置换术的老年患者,随机分为3组:对照组(C组,n=93),氨茶碱2.5 mg/kg组(A1组,n=94),氨茶碱5 mg/kg组(A2组,n=92)。A1组在麻醉诱导后即刻静脉泵注2.5 mg/kg氨茶碱,30 min泵完;A2组在相同的时间点静脉泵注5 mg/kg氨茶碱;C组泵注等体积的5%葡萄糖溶液。所有患者均行常规气管插管全麻。3组患者分别于麻醉诱导前(T0)、机械通气0.5 h(T1)、机械通气1 h(T2)、术毕(T3)行血气分析,并根据相应呼吸参数计算患者的肺动态顺应性(Cd)和静态顺应性(Cs)、氧合指数(OI)、肺泡-动脉氧分压差(A-aDO_(2))。同时记录机械通气时间、手术时间、术中液体输注情况、输血情况、苏醒时间、拔管时间、术后恢复质量及术后7 d肺部并发症发生率。结果3组患者在T0时刻,OI、A-aDO_(2)的差异均无统计学意义(P>0.05)。在T2、T3时间点,A1、A2组的OI、Cd和Cs高于C组,A-aDO_(2)低于C组,差异均有统计学意义(P<0.05);A2组OI、Cd、Cs高于A1组,A-aDO_(2)低于A1组,差异均有统计学意义(P<0.05)。与C组相比,A1、A2组肺部并发症的发生率显著降低,且A2组的发生率比A1组更低(P<0.05)。与C组相比,A1、A2组的苏醒时间和拔管时间显著缩短,拔管后低氧血症发生率也显著降低(P<0.05);且A1组与A2组苏醒时间和拔管时间的差异亦有统计学意义。A1、A2组的15项恢复质量评分量表(QoR15)得分明显高于C组(P<0.05)。3组间术后恶心呕吐发生率无明显差异。结论全麻下静脉输注氨茶碱能显著改善老年全髋关节置换术患者围术期的肺通气和换气功能,显著降低患者肺部并发症的发生率,提高患者恢复质量。Objective To investigate the effect of intravenous infusion of aminophylline on lung function and postoperative pulmonary complications(PPCs)in elderly patients under total hip arthroplasty.Methods A total of 279 elderly patients who were scheduled for total hip arthroplasty under general anesthesia were enrolled.They were randomly divided into three groups:a control group(group C,n=93),an aminophylline 2.5 mg/kg group(group A1,n=94),and an aminophylline 5 mg/kg group(group A2,n=92).Group A1 was intravenously infused with 2.5 mg/kg of aminophylline immediately after anesthesia induction over 30 min.Group A2 was intravenously infused with 5 mg/kg of aminophylline at the same time point.Group C received the same volume 5%glucose solution.All patients underwent routine general anesthesia.Patients in the three groups were compared for blood gas analysis before anesthesia induction(T0),0.5 h after mechanical ventilation(T1),1 h after mechanical ventilation(T2),and after surgery(T3).Meanwhile,the lung dynamic compliance(Cd)and static compliance(Cs),oxygenation index(OI),and alveolar-arterial oxygen difference(A-aDO 2)were calculated according to the corresponding respiratory parameters.Meanwhile,their mechanical ventilation time,surgical time,intraoperative fluid infusion,blood transfusion,recovery time,extubation time,the quality of postoperative recovery,and PPCs within seven days after surgery were also recorded.Results There were no statistical differences in OI and A-aDO 2 at T0 among the three groups.At T2 and T3,groups A1 and A2 showed remarkable increases in OI,Cd and Cs,and decreases in A-aDO 2,compared with group C(P<0.05);group A2 showed remarkable increases in OI,Cd and Cs,and decreases in A-aDO 2,compared with group A1(P<0.05).Compared with group C,the incidence of PPCs in group A1 and group A2 was significantly reduced,and the incidence of PPCs in group A2 was lower than that in group A1(P<0.05).Compared with group C,group A1 and group A2 presented significantly shortened recovery time and extubation time

关 键 词：氨茶碱 术后肺部并发症 肺功能 全髋关节置换术 

分 类 号：R614.2[医药卫生—麻醉学]