70岁及以上肺癌患者胸腔镜围术期应用氨溴索及异丙托溴铵的疗效

摘要

目的 观察70岁及以上肺癌患者在胸腔镜围术期中联合使用氨溴索及异丙托溴铵的效果. 方法 82例胸腔镜下肺癌手术的老年患者(≥70岁),分为试验组42例和对照组40例,试验组使用盐酸氨溴索(沐舒坦)静滴及异丙托溴铵(爱全乐)雾化吸入,而对照组则给予相同体积生理盐水作为参照,比较两组患者入院后、术前及术后5d肺功能和动脉血气分析变化,以及术后肺不张、肺部感染的发生率、再入重症监护室(ICU)的发生率及术后住院天数. 结果 与对照组(80.6±7.6)％、(81.4±7.0)％、(74.6±6.9)％、(81.7±6.9) mmHg、(67.3±10.2)％、(63.0±11.2)％、(60.1±9.2)％、(70.1±11.8)mmHg、25.0％、32.5％、(12.1±2.6)d比较,试验组术前肺功能指标第1秒用力呼气容积占预计值百分比(FEV1％) (87.0±8.2)％、第1秒用力呼气容积占用力肺活量百分比(FEV1/FVC％) (90.4±6.4)％、每分钟最大通气量的实测值/预计值百分比(MVV％) (87.1±5.6)％、血气分析指标动脉血氧分压(PaOe) (86.6±6.2) mmHg、术后第5天FEV1％(76.4±9.2)％、FEV1/FVC％ (74.7±9.1)％、MVV％ (69.5±9.2)％、PaO2 (79.5±11.5) mmHg、术后肺不张7.1％、肺部感染的发生率11.9％及术后住院天数(8.5±1.8)d均优于对照组(t=2.477、2.588、2.937、3.405、2.583、2.987、2.778、2.666、2.351,x2=4.897、5.072,均P＜0.05);而两组患者再入ICU的比例差异无统计学意义(P＞0.05). 结论 70岁及以上肺癌患者围术期联合使用氨溴索及异丙托溴铵可以通过改善通气和换气功能达到有效改善肺功能的目的,有助于降低术后肺部并发症,缩短住院天数.%Objective To evaluate the effect of perioperative administration of Ambroxol combined with Ipratropium on elderly lung cancer patients undergoing thoracoscopic surgery.Methods 82 lung cancer patients aged ≥70 years who were scheduled for thoracoscopic lung resection were randomly assigned into 2 groups:the observation group(n=42) and the control group(n=40).Patients in the observation group were treated with 90 mg Ambroxol(mucosolvan) by intravenous drip and Ipratropium(atrovent) by atomizing inhalation,while patients in the control group were treated with an equal volume of 0.9％ sodium chloride solution.Pulmonary function and changes of arterial blood gases at admission,before surgery and 5 days after surgery,incidences of postoperative atelectasis and pulmonary infection,the rate of return to the intensive care unit(ICU),and the length of postoperative hospital stay were compared between the 2 groups.Results Compared with the control group,the percent predicted forced expiratory volume in 1 second (FEV1％),the ratio of forced expiratory volume in 1 second to forced vital capacity(FEV1/FVC％),the percent predicted maximum ventilation volume per minute (MVV％),and the arterial oxygen pressure (PaO2) were increased in the observation group before surgery [(87.0±8.2)％ vs.(80.6±7.6) ％,(90.4±6.4)％ vs.(81.4±7.0)％,(87.1±5.6)％ vs.(74.6±6.9) ％,(86.6±6.2) mmHg vs.(81.7±6.9)mmHg,t=2.477,2.588,2.937,3.405,respectively,allP＜0.05].TheFEV1％,FEV1/FVC％,MVV％ and PaO2 were higher in the observation group than in the control group 5 days after treatment [(76.4±9.2) ％ vs.(67.3±10.2) ％,(74.7±9.1) ％ vs.(63.0±11.2) ％,(69.5±9.2)％ vs.(60.1±9.2) ％,(79.5±11.5) mmHg vs.(70.1±11.8) mmHg,t 2.583,2.987,2.778,2.666,respectively,all P＜0.05].The incidences of postoperative atelectasis,pulmonary infection and the length of postoperative hospital stay were lower or less in the observation group than in the controlgroup[7.1％ vs.25.0％,11.90％ vs.32.50％,(8.5±1.8) days vs.(12.1±2.6) days,x2=4.897,5.072,2.351,respectively,all P＜0.05].No significant difference in the rate of return to ICU was found between the two groups(P＞0.05).Conclusions The combination of perioperative Ambroxol and Ipratropium can effectively improve lung function by improving ventilation and gas exchange function,reduce postoperative pulmonary complications and shorten the length of postoperative hospital stay in lung cancer patients aged 70 years and over.