西维来司他钠对老年轻度阻塞性通气功能障碍患者胸腔镜术后肺部并发症的影响  

Protective effect of sivelestat sodium on pulmonary complications after thoracoscopic surgery in elderly patients with mild obstructive ventilatory dysfunction

作　　者：李新宁 钟巍[1] LI Xinning;ZHONG Wei(Department of Anesthesiology,He’nan Chest Hospital(Affiliated Chest Hospital of Zhengzhou University),Zhengzhou 450008,China)

机构地区：[1]河南省胸科医院(郑州大学附属胸科医院)麻醉科,郑州450008

出　　处：《上海医药》2024年第11期61-66,共6页Shanghai Medical & Pharmaceutical Journal

基　　金：2020年度河南省医学科技攻关计划联合共建项目(LHGJ20200216)。

摘　　要：目的:探讨西维来司他钠对老年轻度阻塞性通气功能障碍患者胸腔镜手术后肺部并发症的影响。方法:选取择期行胸腔镜肺癌根治术的老年患者180例,随机分成西维来司他钠组(S组)和乌司他丁组(U组),每组90例。S组静脉泵注西维来司他钠,U组静脉泵注乌司他丁。比较两组至出院前的术后肺部并发症(PPCs)发生情况,麻醉诱导前10 min(T_(0))、切皮时(T_(1))、术毕即刻(T_(2))、术后24 h(T_(3))及72 h(T_(4))时的肺泡-动脉血氧分压差(PA-aDO_(2))、肺泡氧合指数(OI)和呼吸指数(RI);术前和术后2 d时的第1秒用力呼气容积占预计值的百分比(FEV_(1)%)、用力肺活量占预计值的百分比(FVC%)和FEV_(1)/FVC;术后气管导管拔管时间、麻醉后恢复室(PACU)入住时间及术后住院时间。结果:S组PACU停留时间短于U组;低氧血症、新出现肺部啰音和支气管痉挛发生率均低于U组;T_(1~4)时,PA-aDO_(2)和RI水平低于U组,OI水平高于U组;FEV_(1)%、FVC%和FEV_(1)/FVC水平高于U组(P<0.05)。结论:西维来司他钠对老年轻度肺功能障碍患者行胸腔镜手术时具有一定的肺保护作用,可降低PPCs的发生。Objective:To investigate the protective effect of sivelestat sodium on pulmonary complications after thoracoscopic surgery in elderly patients with mild obstructive ventilation dysfunction.Methods:One hundred and eighty elderly patients who underwent elective thoracoscopic radical resection of lung cancer were randomly divided into a sivelestat sodium group(group S)and a ulinastatin group(group U)with 90 cases each.Group S and U were intravenously pumped with sivelestat sodium and ulinastatin,respectively.The occurrence of postoperative pulmonary complications(PPCs)before discharge,the alveolar-arterial oxygen partial pressure difference(PA-aDO_(2)),alveolar oxygenation index(OI)and respiratory index(RI)at 10 min before anesthesia induction(T0),skin incision time(T_(1)),immediate time after surgery(T_(2)),postoperative 24 hours(T_(3))and 72 hours(T_(4)),and forced expiratory volume in one second as a percentage of predicted value(FEV_(1)%),forced vital capacity as a percentage of predicted value(FVC%)and FEV_(1)/FVC before operation and on postoperative 2 d;and the time for postoperative endotracheal tube extubation and stay at post-anesthesia care unit(PACU)and postoperative hospital stay were compared between two groups.Results:The PACU stay was shorter,the incidence of hypoxemia,new pulmonary rales and bronchospasm and the levels of PA-aDO_(2) and RI at T_(1-4) were lower,and the levels of OI at T_(1-4),FEV_(1)%,FVC%,and FEV_(1)/FVC were higher in the group S than the group U(P<0.05).Conclusion:Sivelestat sodium has a certain lung protection effect on elderly patients with mild pulmonary dysfunction during thoracoscopic surgery and can reduce the occurrence of PPCs.

关 键 词：西维来司他钠 肺脏 术后肺部并发症 胸外科手术 老年患者 

分 类 号：R979.9[医药卫生—药品] R734.2[医药卫生—药学]