盐酸氨溴索预先给药对食管癌根治术患者单肺通气时肺内分流的影响
发布时间：2018-07-27 09:23
【摘要】：目的单肺通气时最常见的问题是低氧血症。造成低氧血症的原因很多,但主要原因是肺内分流。手术过程中的各种刺激,均可引发肺炎性反应,促使大量炎性因子释放。细胞因子瀑布级联反应和白细胞过度的激活,引起肺部炎症反应,造成肺损伤,促使肺不张的发生。外界刺激引发肺部炎性反应,炎症反应引起炎性因子过度释放,过度释放的炎性因子可加重肺内分流。所以保护肺功能,抑制炎性反应可有效减少肺内分。盐酸氨溴索是新一代黏痰的稀释剂,已经有研究表明,除化痰作用外,氨溴索还有其它的一系列肺保护作用。如促进肺泡表面物质分泌,减小肺表面张力.防止肺泡萎陷;具有抗氧化作用,减轻氧化性肺损伤;具有抗炎作用,可减少炎症细胞及炎性介质的释放,减轻炎症反应引起的肺损伤。本研究将仅限于观察并证实术前静脉注射氨溴索是否有助于减少肺内分流并改善动脉血氧合,并探讨氨溴索是否对食管癌根治术患者具有肺保护作用。研究方法选择行左进胸食管癌根治术患者100例,男65例,女35例,年龄在30~64岁之间,ASAⅠ或Ⅱ级,体重48~80 kg,身高158~182 cm,术前肺功检查结果均正常或仅有轻微通气障碍,无心脏病史,心功能Ⅰ~Ⅱ级,排除肝肾功能异常患者。采用数字表法,将患者随机分为两组(n=50):盐酸氨溴索(M组),生理盐水组(NS组)。M组于麻醉前30 min静滴盐酸氨溴索5 mg/kg,NS组给予等容量生理盐水。在双肺通气10 min(To)、单肺通气35 min(T1)、恢复双肺通气30 min(T2)时采集桡动脉和颈内静脉血样,行血气分析并同时测定MAP、Sp O2、平均气道压(Pmean),计算肺内分流率(QS/QT)。结果两组患者的Pmean以及血流动力学指标相比较差异无统计学意义(P0.5)。与To相比较两组T1、T2时,QS/QT升高,Pa O2降低(P0.5)。与T1比较两组T2时,QS/QT降低,Pa O2升高(P0.5)。与NS组相比较,M组T1、2时QS/QT降低,Pa02升高(P0.05)。结论术前静脉滴注大剂量盐酸氨溴索可减少食管癌根治术患者单肺通气时肺内分流,改善患者氧合功能,具有肺保护作用。
[Abstract]:Objective the most common problem in single lung ventilation is hypoxemia. There are many reasons for hypoxemia, but the main cause is intrapulmonary shunt. All kinds of stimuli during the operation can induce pneumonic response and promote the release of a large number of inflammatory factors. Cytokine cascade reaction and excessive activation of white blood cells cause pulmonary inflammation, lung injury and atelectasis. External stimuli induce pulmonary inflammatory response, inflammatory response causes excessive release of inflammatory factors, excessive release of inflammatory factors can aggravate intrapulmonary shunt. Therefore, the protection of lung function, inhibition of inflammatory response can effectively reduce intrapulmonary score. Ambroxol hydrochloride is a new generation of diluent for mucus phlegm. It has been shown that ambroxol has a series of pulmonary protective effects in addition to the role of phlegm. If promote alveolar surface matter secretion, reduce lung surface tension. It can prevent alveolar collapse; have antioxidant effect and reduce oxidative lung injury; have anti-inflammatory effect, can reduce the release of inflammatory cells and inflammatory mediators, and alleviate lung injury caused by inflammatory reaction. This study will be limited to observing and verifying whether intravenous ambroxol before operation can reduce intrapulmonary shunt and improve arterial oxygenation, and to explore whether ambroxol has lung protective effect on patients undergoing radical resection of esophageal cancer. Methods 100 patients (65 males and 35 females) undergoing radical resection of left thoracic esophageal carcinoma were selected. The age of ASA 鈪，
本文编号：2147357
[Abstract]:Objective the most common problem in single lung ventilation is hypoxemia. There are many reasons for hypoxemia, but the main cause is intrapulmonary shunt. All kinds of stimuli during the operation can induce pneumonic response and promote the release of a large number of inflammatory factors. Cytokine cascade reaction and excessive activation of white blood cells cause pulmonary inflammation, lung injury and atelectasis. External stimuli induce pulmonary inflammatory response, inflammatory response causes excessive release of inflammatory factors, excessive release of inflammatory factors can aggravate intrapulmonary shunt. Therefore, the protection of lung function, inhibition of inflammatory response can effectively reduce intrapulmonary score. Ambroxol hydrochloride is a new generation of diluent for mucus phlegm. It has been shown that ambroxol has a series of pulmonary protective effects in addition to the role of phlegm. If promote alveolar surface matter secretion, reduce lung surface tension. It can prevent alveolar collapse; have antioxidant effect and reduce oxidative lung injury; have anti-inflammatory effect, can reduce the release of inflammatory cells and inflammatory mediators, and alleviate lung injury caused by inflammatory reaction. This study will be limited to observing and verifying whether intravenous ambroxol before operation can reduce intrapulmonary shunt and improve arterial oxygenation, and to explore whether ambroxol has lung protective effect on patients undergoing radical resection of esophageal cancer. Methods 100 patients (65 males and 35 females) undergoing radical resection of left thoracic esophageal carcinoma were selected. The age of ASA 鈪，
本文编号：2147357
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