沙丁胺醇对慢性阻塞性肺疾病患者单肺通气早期呼吸力学的影响

Effects of Salbutamol on Respiratory Mechanics during One-lung Ventilation Early in Patients with Chronic Obstructive Pulmonary Disease

目的麻醉诱导前吸入硫酸沙丁胺醇气雾剂(万托林),观察其对单肺通气早期呼吸力学的影响。方法合并慢性肺阻塞疾患(COPD)拟行肺叶切除手术的患者40例,随机分成观察组和对照组各20例,观察组:患者给予万托林200μg(2揿)后面罩吸氧;对照组:单纯面罩吸氧,30 min后开始麻醉诱导。记录监测时点的血气分析以及气道峰压、气道平台压、气道阻力、胸肺顺应性的变化。结果麻醉诱导前、双肺通气、单肺通气10 min及20 min的PaCO2观察组低于对照组,PaO2观察组高于对照组,P<0.05或P<0.01。双肺通气、单肺通气10 min及20 min的气道峰压、气道平台压、气道阻力观察组低于对照组,胸肺顺应性观察组高于对照组,P<0.05。结论硫酸沙丁胺醇气雾剂能降低COPD患者单肺通气早期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,提高了麻醉手术的安全性。

OBJECTIVE To study the effects of salbutamol aerosol inhalation prior to anesthesia induction on respiratory mechanics during one lung ventilation early in patients with chronic obstructive pulmonary disease. METHODS Forty patients with concomitant COPD, scheduled for lobectomy were randomly allocated into observation group（n=20） and control group（n=20）. Salbutamol aerosol 200 pg （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 min oxygenation in both groups. Changes of blood gas analysis, peak and platform pressure of airway, airway resistance and chest-lung compliance were monitored. RESULTS Compared with control group, value of PaCOz in anesthesia induction , double lung ventilation, 10 minutes and 20 minutes after one lung ventilation were lower in observation group, however, PaO2 were higher in respective time, P〈0.05 or P〈0.01; When compared with control group,the peak of and platform pressure of airway, airway resistance in double lung ventilation, 10 minutes and 20 minutes after one lung ventilation were lower in observation group and chest-lung compliance was higher in observation group, P〈0.05. CONCLUSION Salbutamol aerosol inhalation can reduce airway pressure and airway resistance and increase chest-lung compliance during one lung ventilation in patients with COPD. It can improve anestheia safety and it is advantageous for breathing management during operation.