不同雾化吸入方案对老年腹部手术后肺部并发症影响的疗效观察

The influence of different inhalation treatment on the postoperative pulmonary complications in elderly patients undergoing major abdominal surgery with general anesthesia.

目的观察布地奈德混悬液联合氨溴索氧气驱动雾化吸入治疗老年腹部手术患者术后肺部行发症的效果，方法将2011年1月至2013年7月上海市安亭医院外科收治的老年腹部手术患者202例随机分为2组，每组101例所有患者均于气管内插管全凭静脉麻醉下行腹部手术治疗。治疗组采用布地奈德混悬液联合氨溴索雾化吸入，对照组采用地塞米松加糜蛋白酶、庆大霉素雾化吸入，记录和比较2组术后血常规、C反应蛋白（CRP）、血气分析、痰液量及患者的咳嗽咳痰症状评分。结果术后连续3d内2组的白细胞计数、中性粒细胞比例和CRP差异无统计学意义。术后第3天治疗组的氧分压高于对照组（P=0．000），治疗组在痰液量、咳嗽咳痰症状改善方面优于对照组，治疗组的术后肺部并发症发病率（9．90％）比对照组（22．77％）低，两者差异有统计学意义（P=0．026）。结论布地奈德混悬液联合氨溴索雾化吸入治疗老年患者术后肺部并发症的效果优于传统的地塞米松加糜蛋白酶、庆大毒素。能改善患者术后咳嗽、咳痰症状，改善老年患者术后肺部氧合功能，能降低术后肺部行发症发病率，值得进一步推广。

Objective To investigate the influence of Budesonide and mucosolvan inhalation on the postoperative pulmonary complications following the aged abdominal surgical patients. Methods 202 patients who underwent surgery at An- Ting Hospital JiaDing, Shanghai were enrolled and randomly assigned the treatment group （n = 101） and the control group （n = 101）. Budesonide and mucosolvan were inhaled by patients in the treatment group propelled by high flow oxygen while dexamethasone, gentamycin and chymotrypsin in the control group. The difference of postoperative white blood cell , neu-trophil percentage, blood gas analysis , score of the cough and so on as well as incidence of postoperative pulmonary complications and mortality in two groups were studied. Results The postoperative white blood cell , neutrophil percentage and CRP had no differences between the two groups, on the third day after operation in the treatment had been conspicuously improved. The volum of expectorated sputum, the score of the congh and expectoration symptom of the treatment group were lower than those of the control group. There were significant differences of incidence of postoperative pulmonary complications in two groups （P=0.026）. Conclusion Budesonide and mucosolvan inhalation can improve the postoperative cough and expectoration symptoms, which was advised to be put into clinical practice.