沙丁胺醇对慢性阻塞性肺疾病患者腹腔镜胆囊切除术呼吸力学的影响

摘要

目的 探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者择期行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)麻醉诱导前吸入硫酸沙丁胺醇气雾剂(万托林)对呼吸力学的影响. 方法 2010年3月～2012年2月30例COPD择期行LC,随机分成观察组和对照组各15例,观察组给予硫酸沙丁胺醇气雾剂200 μg后面罩吸氧,对照组单纯面罩吸氧,30 min后开始麻醉诱导.记录入室时(T0)、麻醉诱导前(T1)、插管后5 min(T2)、人工气腹后5 min(T3)和30 min(T4)血气分析值.记录患者插管后5 min(T2)、人工气腹后5 min(T3)、30 min(T4)的气道峰压、气道平台压、气道阻力、胸肺顺应性的变化.结果 2组患者气腹后5、30 min气道峰压、气道平台压、气道阻力明显高于插管后5 min(P＜0.05),但胸肺顺应性3个时点无统计学差异(观察组:F =0.94,P=0.397;对照组:F=0.73,P=0.486)；观察组插管后5 min(T2)气道峰压、气道平台压、气道阻力明显低于对照组,分别为:[(17.6±2.1) cmH2O vs.(22.9±2.0)cm H2O,t=-7.078,P=0.000;(14.6±1.8)cm H2Ovs.(18.4±1.8)cm H2O,t=-5.781,P=0.000;(14.9±2.1)cm H2O· L/s vs.(17.9±1.5)cm H2O·L/s,t=-4.502,P=0.000]；观察组气腹后5 min(T3)气道峰压、气道平台压、气道阻力明显低于对照组,分别为:[(21.6±1.9)cm H2O vs.(26.4±1.4)cm H2O,t=-7.877,P=0.000;(18.5±1.3) cm H2O vs.(23.5±1.6)cm H2O,t=-9.393,P=0.000;(19.1±2.3)cm H2O·L/s vs.(24.3±1.9)cm H2O·L/s,t=-6.750,P=0.000]；观察组气腹后30 min(T4)气道峰压、气道平台压、气道阻力明显低于对照组,分别为:[(21.5±1.6) cmH2O vs.(26.7±1.6)cm H2O,t=-8.900,P=0.000;(19.7±2.2)cm H2O vs.(24.7±2.0)cm H2O,t=-6.513,P =0.000;(18.9±1.2)H2O· L/s vs.(24.6 ±2.1)H2O·L/s,t=-9.127,P=0.000]；观察组插管后5 min(T2)、气腹后5 min(T3)及气腹后30 min(T4)胸肺顺应性高于对照组,分别为:[(55.3±11.2)ml/cm H2O vs.(41.4±10.2)ml/cm H2O,t =3.553,P =0.001;(50.1±10.9)ml/cm H2O vs.(36.4±11.1)ml/cm H2O,t=3.410,P=0.002;(51.7±9.7) ml/cm H2O vs.(38.7±12.5)ml/cm H2O,t =3.182,P=0.005]. 结论 硫酸沙丁胺醇气雾剂能降低COPD患者LC的气道压力和气道阻力,增加胸肺顺应性,有利于术中呼吸管理,提高了麻醉的安全性.%Objective To study the effect of salbutamol aerosol inhalation prior to anesthesia induction on pneodynamic during laparoscopic cholecystectomy (LC) in patients with chronic obstructive pulmonary disease (COPD). Methods 30 patients with concomitant COPD, who were scheduled for LC were randomly allocated into observation (n = 15) and control groups (n = 15). Salbutamol aerosol 200 μg (two puffs) were administered according to instructions before oxygenation via mask in observation group, whereas in control group no aerosol was given before oxygenation via mask. Anesthesia induction was initiated after 30 minutes oxygenation in both the groups. Blood gas analysis, change of peak and platform pressure of the airway, airway resistance and chest-lung compliance were monitored during the procedure. All the measurements were recorded when entering the operating room ( T0 ) , before anesthesia induction ( T1) , 5 min after intubation (T2 ) , and 5 and 30 min after pneumoperitoneum ( T3 and T4 ). Results In both the groups, the peak and flat pressure and resistance of the airway at T3 and T4 were significantly higher than those at T2, whereas no significant difference was detected in chest-lung compliance among the three time points (observation group: F =0. 94, P = 0.397; control group: F = 0. 73, P = 0.486). At T2, T3 and T4 , observation group showed significantly lower peak and flat pressure and resistance of the airway than those in the control [ T2: ( 17. 6 ±2. 1) cm H20 vs. (22.9±2.0) cmH2O, t= -7.078, P =0.000; (14.6 ±1.8) cm H20 vs. (18.4 ±1.8) cm H20, t= -5.781, P = 0. 000; and(14. 9 ± 2. 1) cm H20 o L/s vs. (17.9±1.5)cm H20 o L/s,t = -4. 502, P =0. 000. T3 : (21.6 ±1.9) cm H20 vs. (26.4 ±1.4) cm H20, t= -7.877, P = 0.000; (18.5 ±1.3) cm H20 vs. (23.5 ±1.6) cm H20, t= -9. 393, P =0.000; and (19.1 ±2. 3) cm H20 o L/s vs. (24.3 ± 1.9) cm H20 · L/s, t= -6.750, P = 0.000. T4: (21.5 ±1.6) cm H20 vs. (26.7 ±1.6) cmH20, t= -8.900, P=0.000; (19.7 ±2.2) cm H20 vs. (24.7 ±2.0) cm H20, t= -6.513, P =0.000; and (18.9 ±1.2) H20 · L/s vs. (24. 6 ±2. 1) H20 · L/s, t= -9.127, P = 0.000; respectively]. Besides, the observation group showed significantly higher chest-lung compliance than the control at T2, T3 and T4 [ (55. 3 ± 11. 2) ml/cm H20 vs. (41.4 ±10. 2) ml/cm H20, t = 3. 553, P = 0. 001; (50. 1 ± 10.9) ml/cm H20 vs. (36. 4 ± 11. 1) ml/cm H20, t = 3. 410, P =0.002; (51.7 ±9.7) ml/cm H20 vs. (38. 7 ± 12.5) ml/cm H20, t =3. 182, P =0.005]. Conclusions Salbutamol aerosol inhalation reduces airway pressure and resistance, increases chest-lung compliance in patients with COPD during LC. It benefits to pneodynamic and improve anesthesia safety.