两种雾化吸入方案对老年腹部外科病人术后肺部并发症影响研究

Intluence of budesonide and mucosolvan aerosol inhalation on postoperative pulmonary complications following the aged abdominal surgical patients

目的观察布地奈德雾化混悬液联合氨溴索和地塞米松注射剂联合氨溴索两种雾化吸入方案对老年腹部外科病人术后肺部并发症的影响。方法对2009年11月至2010年6月南京军区南京总医院诊治199例择期老年手术病人的临床资料进行分析。将199例病人随机分为治疗组(99例)和对照组(100例),治疗组采用布地奈德雾化混悬液联合氨溴索、对照组采用地塞米松注射剂联合氨溴索雾化吸入。观察两组术后生命体征、皮质醇、促肾上腺皮质激素(ACTH)等变化及术后肺部并发症(PPCs)发生率和病死率的差异。结果与对照组相比,治疗组术后第3天脉氧、氧分压明显改善。两组术后第1天、第2天皮质醇的变化差异有统计学意义。治疗组术后3dACTH水平明显高于对照组(P<0.001)。但两组PPCs发生率、病死率差异无统计学意义。结论布地奈德混悬液联合氨溴索雾化吸入对机体下丘脑-脑垂体-肾上腺轴(HPA轴)的影响小,更为安全,同时可以改善老年病人术后肺部氧合功能。

Objective To investigate the influence of two aerosol inhalation programs on postoperative pulmonary complications following the aged abdominal surgical patients. Methods The clinical data of 199 aged abdominal surgical patients admitted between November 2009 and June 2010 at Nanjing General Hospital of Nanjing Military Command were analyzed. All the patients were randomized to treatment group （n=99） and control group （n=100）. Treatment group were given budesonide and mucosolvan inhalation, and the control group were given dexamethasone and mucosolvan inhalation. The differences of postoperative vital sign, cortisol, ACTH and so on, as well as incidence of postoperative puhnonary complications and mortality in two groups were studied. Results Compared with the control group, SaO2 and PO2 on the third day after operation in treatment group had conspicuous improvement. There were significant differences of postoperative cortisol level in two groups, especially on the first day and the second day after operation. ACTH level of three days after operation in treatment group was much higher than control group （P〈0.001）. There were no significant differences of incidenee of postoperative puhnonary complications and mortality in two groups. Conclusion Budesonide arid mucosolvan inhalation has less effect on hypothalamic-pituitary-adrenocortica axis （HPA）, and is more safe. Meanwhile it can improve postoperative oxygenation of the aged patients.