探究不同剂量沐舒坦对肺癌术后患者肺部并发症的防治效果

发布时间：2018-02-26 05:03

本文关键词： 不同剂量沐舒坦肺部并发症防治效果　出处：《山西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景：肺部感染及肺不张等肺部并发症的发生直接关系普胸术后患者，尤其是老年患者的恢复情况，因此怎样有效的对肺部并发症进行防治一直就是胸外科的研究课题。随着医疗水平的发展，患者年龄的增大，肺部保护的方法也得以迅速进展。但是在临床上，尽管使用各种方法进行肺部保护，但是手术操作时间的延长以及术中麻醉插管的损伤等，仍然存在术后肺部感染及肺不张等肺部并发症发生的潜在危险，特别是老年患者，胸部手术后更容易发生肺部并发症。近年来随着对普胸术后肺部并发症发生机理的了解，部分学者建议使用沐舒坦对普胸术后肺部并发症进行防治，以降低普胸术后肺部并发症的发生率。国内外研究表明，沐舒坦对术后肺的保护作用明显，尤其是大剂量使用时，对普胸术后肺有良好的保护作用。但是，目前在沐舒坦的使用剂量的选择以及具体使用时间上暂无统一标准，国内外对各剂量沐舒坦的临床应用及作用机制均处于探索研究阶段。目的：（1）探究不同剂量沐舒坦对普胸术后患者肺部并发症的不同防治效果；（2）为临床降低普胸术后肺部并发症发生率提供依据；（3）初步探讨普胸术后肺部并发症的发生机制以及沐舒坦对于普胸术后肺部并发症防治的意义及其基本作用机理。方法：选取山西省肿瘤医院胸外科2012年-2013年非小细胞肺癌术后患者60例作为研究对象，所有研究对象均为山西省肿瘤医院胸外科同一组医师施行手术治疗，手术方式均为经双腔气管插管全身麻醉下行肺叶切除。将所有患者随机分为3组，大剂量组20例，中等剂量组20例，小剂量组20例，术后除常规抗感染以及营养支持治疗外，大剂量组给予1000mg/d沐舒坦持续静脉泵入，，中等剂量组给予600mg/d沐舒坦持续静脉泵入，小剂量组给予300mg/d沐舒坦持续静脉泵入。连续使用7天后根据3组患者术后痰培养、痰液性状、临床表现、胸片、体格检查、咳痰难易程度以确定肺部感染、肺不张等肺部并发症发生率，并做出研究比较。结果：（1）大剂量组、中等剂量组、小剂量组患者术后7天肺部感染发生率均有差异，差异有统计学意义（p＜0.05），大剂量组患者术后7天肺部感染发生率低于中等剂量组和小剂量组；（2）大剂量组、中等剂量组、小剂量组患者术后7天肺不张发生率均有差异，差异有统计学意义（p＜0.05），大剂量组患者术后7天肺不张发生率低于中等剂量组和小剂量组；（3）大剂量组、中等剂量组、小剂量组患者术后7天肺部并发症发生率均有差异，差异有统计学意义（p＜0.05），大剂量组患者术后7天肺部并发症发生率低于中等剂量组和小剂量组。结论：(1)大剂量沐舒坦对普胸术后患者肺部感染的防治效果明显优于中等剂量组和小剂量组； (2)大剂量沐舒坦对普胸术后患者肺不张的防治效果明显优于中等剂量组和小剂量组；（3）大剂量沐舒坦能有效降低普胸术后肺部感染以及肺不张等肺部并发症发生率。
[Abstract]:Background: direct relationship after thoracic operation in patients with pulmonary infection and atelectasis and pulmonary complications, especially in elderly patients with the recovery, so how to effectively carry out the prevention and treatment of pulmonary complications has been the Department of thoracic surgery research topic. With the development of medical level, increasing patient age, method of lung protection rapidly progress in clinical. However, despite using a variety of methods for lung protection, but the operation time and intraoperative anesthesia intubation injury, there is still a potential risk of pulmonary infection and atelectasis and postoperative pulmonary complications, particularly in elderly patients after thoracic surgery more prone to pulmonary complications.
In recent years, with the mechanism of pulmonary complications after thoracic operation understanding, some scholars have suggested that the use of ambroxol on pulmonary complications after thoracic operation control after thoracic operation in order to reduce the incidence of pulmonary complications. Studies indicate that, for the protection of ambroxol on lung surgery is obvious, especially in large doses that has a good protective effect on the lung after thoracic operation. However, at present the selection and dosage of specific time use no unified standard, clinical application and mechanism of action of different dose of ambroxol at home and abroad are in the stage of study.
Objective: (1) to explore the different control effects of different dose of ambroxol in patients with pulmonary complications after thoracic operation;
(2) to provide a basis for reducing the incidence of pulmonary complications after general thoracic surgery.
(3) preliminary study of Thoracic Postoperative pulmonary complications and the mechanism of ambroxol significance for preventing pulmonary complications after thoracic operation and its basic mechanism.
Methods: Department of thoracic surgery, Tumor Hospital of Shanxi province in 2012 -2013 non-small cell lung cancer after surgery in 60 patients as the research object, all of the subjects were in Department of thoracic surgery, Tumor Hospital of Shanxi province with a group of doctors surgery, surgical methods are the double lumen endotracheal intubation and general anesthesia lobectomy. All patients were randomly divided into the 3 group, 20 cases of high-dose group, middle dose group 20 cases, 20 cases of small dose group, in addition to conventional anti infection and postoperative nutritional support treatment, high-dose group received continuous intravenous infusion of ambroxol 1000mg/d, medium dose group were given 600mg /d ambroxol intravenous small dose group was given ambroxol intravenous 300mg/d the use of continuous pump. After 7 days of culture, according to the 3 groups of patients with postoperative sputum characteristics, clinical manifestations, chest X-ray examination, sputum, difficulty to determine pulmonary infection, atelectasis and pulmonary complications And make a comparison of the research.
Results: (1) the incidence of pulmonary infection in the high-dose group, the moderate dose group and the low-dose group was different on the 7 day after operation, and the difference was statistically significant (P < 0.05). The incidence of pulmonary infection in the high-dose group was lower than that in the moderate dose group and the low-dose group 7 days after operation.
(2) the incidence of atelectasis in the high-dose group, the moderate dose group and the low-dose group was different on the 7 day after operation. The difference was statistically significant (P < 0.05). The incidence of atelectasis in the high-dose group on the 7 day after operation was lower than that in the moderate dose group and the low dose group.
(3) the incidence of pulmonary complications in the high-dose group, the moderate dose group and the low-dose group was different on the 7 day after operation. The difference was statistically significant (P < 0.05). The incidence of pulmonary complications in the high-dose group on the 7 day after operation was lower than that in the moderate dose group and the low dose group.
Conclusion: (1) large dose of ambroxol on prevention and treatment effect of patients with pulmonary infection after thoracic operation was significantly better than the medium dose group and small dose group;
(2) large dose of ambroxol on prevention and treatment effect of patients with atelectasis after thoracic operation is obviously better than the medium dose group and small dose group;
(3) large dose of ambroxol can effectively reduce Thoracic Postoperative pulmonary infection and atelectasis and pulmonary complications.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R734.2

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