布地奈德联合复方异丙托溴铵雾化吸入对尘肺病大容量全肺灌洗围术期患者的疗效影响

发布时间：2018-03-07 12:03

本文选题：布地奈德　切入点：复方异丙托溴铵　出处：《中国药房》2017年05期 　论文类型：期刊论文

【摘要】：目的:探讨布地奈德联合复方异丙托溴铵雾化吸入对尘肺病大容量全肺灌洗(WLL)围术期患者的疗效和安全性影响。方法:选取我院2014年12月-2016年5月全身麻醉完成WLL术的尘肺病男性患者150例,按照随机数字表法分为治疗组和对照组,各75例。两组患者均采用全身静脉复合麻醉,并采用WLL术和间歇与呼吸机呼吸频率同步的纯氧手动正压通气交替负压吸引;治疗组患者在术前3 d至术后3 d给予吸入用布地奈德混悬液2 mL,bid+吸入用复方异丙托溴铵溶液2.5 mL,tid,雾化吸入。观察两组患者不同灌洗阶段的动脉血气指标[血酸碱度(pH)、血氧分压(PaO_2)、血二氧化碳分压(PaCO_2)和剩余碱(BE)]水平,术前3 d和术后7 d的肺功能指标[用力肺活量(FVC)、最大通气量(MVV)和第一秒用力呼气容积(FEV1)占FVC比值]水平、血气指标水平和临床症状评分,并记录不良反应发生情况。结果:单/双侧肺灌洗毕双肺通气20min后,两组患者PaO_2均较术前明显升高,差异有统计学意义(P0.05),但组间比较差异无统计学意义(P0.05)。术后3d,两组患者FVC、MVV、FEV1/FVC、PaO_2均明显升高,PaCO_2和临床症状评分均明显降低,且治疗组患者FVC、FEV1/FVC、PaO_2和临床症状评分明显优于对照组,差异有统计学意义(P0.05)。治疗组患者气道痉挛、低氧血症和气道压增高的发生率均明显低于对照组,差异有统计学意义(P0.05)。结论:给予WLL围术期的尘肺病患者布地奈德联合复方异丙托溴铵雾化吸入的辅助治疗,可提高WLL的临床疗效,减少术中不良反应的发生。
[Abstract]:Objective: to investigate the efficacy and safety of budesonide combined with compound ipratropium bromide atomization inhalation in patients with pneumoconiosis during the perioperative period of massive whole-lung lavage. Methods: general anesthesia was performed in our hospital from December 2014 to May 2016. One hundred and fifty male patients with pneumoconiosis underwent WLL procedure. According to the method of random number table, the patients were divided into treatment group (n = 75) and control group (n = 75). The patients in both groups were anesthetized by general intravenous compound anesthesia. The patients in both groups were subjected to WLL's operation and alternating negative pressure suction of pure oxygen manual positive pressure ventilation, which was synchronized with the breathing frequency of ventilator. The patients in the treatment group were treated with inhaled budesonide suspension 2 mL / L bid and inhaled with compound ipratropium bromide solution 2.5 mL / L tid from 3 days before operation to 3 days after operation. The arterial blood gas index [serum acid] in different lavage stages was observed in the two groups. Alkalinity (pH), partial pressure of oxygen (Pao _ 2), partial pressure of blood carbon dioxide (Paco _ 2) and residual alkaloid (BEB)], The pulmonary function indexes (forced vital capacity (VV), maximal ventilation volume (VV) and forced expiratory volume (FEV1) in FVC) were measured 3 days before operation and 7 days after operation. The blood gas index level and clinical symptom score were measured. Results: PaO_2 in both groups was significantly higher than that before operation after 20 minutes of bilateral lung lavage and ventilation. The difference was statistically significant (P 0.05), but there was no significant difference between the two groups (P 0.05). On the 3rd day after operation, the two groups significantly increased the scores of Paco _ 2 and clinical symptoms, and the scores of FVCFEV _ 1 / FVCCU Pao _ 2 and clinical symptoms in the treatment group were significantly higher than those in the control group, and the scores of FVCFEV _ 1 / FVCCIO2 and clinical symptoms in the treatment group were significantly higher than those in the control group, and the clinical symptom scores of the patients in the treatment group were significantly higher than those in the control group. The incidence of airway spasm, hypoxemia and airway pressure in the treatment group was significantly lower than that in the control group. Conclusion: the adjuvant treatment of budesonide combined with compound ipratropium bromide inhalation in patients with pneumoconiosis during WLL perioperative period can improve the clinical efficacy of WLL and reduce the incidence of adverse reactions during operation.
【作者单位】：重庆煤炭职业病医院尘肺科;
【分类号】：R135.2

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