左旋精氨酸雾化吸入对合并肺动脉高压的肺叶切除患者围手术期肺保护的研究

摘要

目的 研究合并肺动脉高压患者行肺叶切除术后早期给予左旋精氨酸雾化吸入对肺换气功能的保护作用,以及对降低术后并发症发生率的预防作用.方法 将54例行肺叶切除术且术前合并肺动脉高压的患者随机分为两组:精氨酸组术后4h之内给予左旋精氨酸雾化吸入;对照组给予等量的生理盐水雾化吸入,术后其他治疗用药与精氨酸组相同.比较两组患者氧合指数、肺泡-动脉氧分压差,一氧化氮浓度及超声心动图、机械通气、滞留ICU、血流动力学紊乱及心律失常发生情况及术后住院日的差异.结果 精氨酸组氧合指数、血浆中一氧化氮含量高于对照组(P＜0.001),肺泡-动脉氧分压差、超声心动图估测术后肺动脉压低于对照组(P＜0.001),术后机械通气、滞留ICU、心律失常及血流动力学紊乱发生率均低于对照组(P＜0.05).结论 术后早期雾化吸入左旋精氨酸对合并肺动脉高压的肺叶切除术患者有积极的肺保护作用,可降低此类患者围手术期并发症的发生率,并缩短住院时间.%Objective To study l-arginine aerosolized inhalation's protective effect on pulmonary ventilation of the pulmonary-arterial-hypertension patients during the early stage after pulmonary lobectomy,and its preventive effect on reducing postoperative complications.Methods 54 cases of pulmonary lobectomy patients with preoperative plumonary arterial hypertension were divided into two groups randomly-Group A was given L-arginine aerosolized inhalation within 4 h after the operation;Group B was given the same dose of aerosolized inhalation of physiological saline as contrast(other postoperative medication being the same with Group A).Compare the two groups of patients in terms of oxygenation index(PaO2/FiO2),alveolararterial oxygen difference(PA-aO2),nitric oxide(NO) concentration,ultrasonic cardiogram,mechanical ventilation duration,ICU duration,occurances of hemodvnamic disturbance and arrhythmia,and differences in postoperative hospital stay.Results The oxgenation index and the content of NO in plasma of Group A were higher than that of Group B(P ＜0.001);the alveolar-arterial oxygen difference and the postoperative pulmonary arterial pressure detected by UCG of Group A were lower than that of Group B(P ＜ 0.001);the postoperative mechanical ventilation duration,ICU duration,occurances of hemodynamic disturbance and arrhythmia of Group A were all lower than that of Croup B(P ＜ 0.05).Conclusion The postoperative l-arginine aerosolized inhalation during the early stage after pulmonary lobectomy has positive effect on the lung protection of the pulmonary-arterial-hypertension patients and it can reduce the perioperative complications and postoperative hospital stay of such patients.