格隆溴铵联合布地奈德吸入剂在胸腔镜肺叶切除围手术期心肺保护有效性和安全性研究  

Efficacy and safety of glycopyrronium bromide combined with budesonide inhalant for cardiopulmonary protection during perioperative thoracoscopic lobectomy

作　　者：王凯[1] 徐茂华 张念亮[1] 褚翔鹏[2] 张家华[1] 崔荣生[1] 李宝强 WANG Kai;XU Mao-hua;ZHANG Nian-liang(Department of Anesthesiology,Rizhao People's Hospital,Rizhao Shandong 276800,China)

机构地区：[1]日照市人民医院麻醉科,山东日照276800 [2]日照市人民医院胸外科,山东日照276800

出　　处：《临床和实验医学杂志》2023年第22期2394-2399,共6页Journal of Clinical and Experimental Medicine

基　　金：山东省医药卫生科技发展计划项目(编号:202104111102)。

摘　　要：目的探究格隆溴铵联合布地奈德吸入剂在胸腔镜肺叶切除围手术期心肺保护中的有效性和安全性。方法前瞻性选取2022年7月至2023年3月日照市人民医院收治的全身麻醉择期行胸腔镜肺叶切除术的80例患者为研究对象。根据麻醉诱导前处理方式分为正常全身麻醉组(C组)、全身麻醉格隆溴铵组(G组)、全身麻醉雾化吸入布地奈德组(B组)、全身麻醉格隆溴铵联合雾化吸入布地奈德组(G+B组),每组各20例。比较各组患者麻醉诱导前(T_(1))、插管时即刻(T_(2))以及气管拔管时(T_(3))的平均动脉压和心率;分别于术前和术后7 d收集各组患者肺功能指标[1 s用力呼气量(FEV1)和用力肺活量(FVC)]并测定术前、用药后3 h、术后6 h和术后24 h的白细胞介素(IL)-6、IL-10和肿瘤坏死因子α(TNF-α)的水平。记录术后不良反应和肺部并发症的发生情况。结果G组T_(1)时的心率显著高于C组,T_(2)时的B组与G+B组心率显著低于C组,B组与G+B组T_(2)时的心率显著低于G组,差异均有统计学意义(P<0.05)。术后7 d,4组FEV1与FVC水平均较术前显著增加,且G组、B组、G+B组的FEV1水平显著高于C组,同时B组FEV1水平显著高于G组,G+B组FEV1水平显著高于G组和B组,差异均有统计学意义(P<0.05);G+B组的FVC水平显著高于C组、G组和B组,差异均有统计学意义(P<0.05)。4组患者术后6、24 h的血清IL-6、IL-10和TNF-α水平均较术前明显升高,G组、B组、G+B组的术后6、24 h的血清IL-6、IL-10和TNF-α水平均显著低于C组,G+B组血清IL-6和IL-10水平显著低于G组和B组,差异均有统计学意义(P<0.05)。G组与G+B组患者术后不良反应发生率分别为40.00%、30.00%,显著低于C组(75.00%),差异有统计学意义(P<0.05)。G+B组患者并发症发生率为5.00%,显著低于C组(30.00%),差异有统计学意义(P<0.05)。结论使用格隆溴铵与布地奈德吸入剂联合应用于胸科手术围术期心肺功能的稳定剂,可以有效改�Objective To explore the effectiveness and safety of glycopyrronium bromide combined with budesonide inhalation in cardiopulmonary protection during perioperative thoracoscopic lobectomy.Methods Eighty patients who undergoing thoracoscopic lobectomy under general anesthesia admitted to Rizhao People's Hospital from July 2022 to March 2023 were prospectively selected as the subjects.According to the treatment methods before anesthesia induction,the patients were divided into normal general anesthesia group(group C),general anesthesia glycopyrronium bromide group(group G),general anesthesia aerosol inhalation of budesonide group(group B),glycopyrronium bromide combined with general anesthesia aerosol inhalation of budesonide group(group G+B),with 20 patients in each group.The mean arterial pressure and heart rate were compared before anesthesia induction(T_(1)),immediately after intubation(T_(2))and during tracheal extubation(T_(3)).Lung function indicators[forced expiratory volume in 1 second(FEV1)and forced vital capacity(FVC)]were collected before surgery and 7 days after surgery and the levels of interleukin(IL)-6,IL-10 and tumor necrosis factor-α(TNF-α)were determined before surgery,3 h after medication,6 h after surgery and 7 days after surgery.The occurrence of postoperative adverse reactions and pulmonary complications were recorded.Results The heart rate of group G at T_(1)was significantly higher than that of group C,the heart rate of group B and group G+B at time T_(2)was significantly lower than that of group C,and the heart rate of group B and group G+B at T_(2)was significantly lower than that of group G,the differences were statistically significant(P<0.05).The levels of FEV1 and FVC in the four groups increased significantly 7 days after surgery,the levels of FEV1 in group G,group B and group G+B were significantly higher than those of group C at 7 d after surgery,the levels of FEV1 in group G,group B,and group G+B were significantly higher than those in group C,while the levels of FEV1 in group B

关 键 词：格隆溴铵 布地奈德 胸腔镜肺叶切除术 安全性 

分 类 号：R614[医药卫生—麻醉学]