盐酸氨溴索对老年妇科腹腔镜手术患者术中肺通气功能的影响

The effects of ambroxol hydrochloride on lung ventilation function during gynecologic laparoscopic surgery in aged patients

目的探讨术前应用盐酸氨溴索对老年妇科腹腔镜患者术中肺通气功能的影响。方法选择择期腹腔镜下老年子宫切除术患者60例,采用信封法随机分为氨溴索组和对照组,每组30例。氨溴索组在气管插管后10min缓慢静注盐酸氨溴索150mg,对照组静注等量生理盐水。记录给药前（T0）、气腹后5 min（T1）、30 min（T2）、60 min（T3）及气管拔管前（T4）时患者HR、MAP、SpO2、PETCO2、肺顺应性（Compl）、气道阻力（Raw）、气道峰压（Ppeak）、平台压（Pplat）与术中尿量、手术时间、输血输液量。结果与T0时比较,T1~T3时两组患者Ppeak、Pplat明显升高,T1~T4时两组Compl明显下降,T2时两组Raw明显升高（P〈0.05）。与对照组比较,T2、T3时氨溴索组患者Ppeak和Pplat明显降低,T2~T4时Compl明显升高,T3时Raw明显降低（P〈0.05）。与T0时比较,两组患者在T1时HR明显增快、MAP明显升高（P〈0.05）,PETCO2在T1~T3均明显升高（P〈0.05）,但仍在正常范围内。结论妇科腹腔镜术前应用氨溴索可有效改善老年患者气腹后肺通气功能,降低气道阻力,提高肺顺应性。

Objective To investigate the effects of preoperative ambroxol hydrochloride on lung ventilation function during gynecologic laparoscopic surgery in aged patients. Methods Sixty aged pa- tients scheduled for gynecologic laparoscopic surgery, by using sealed envelope containing randomiza- tion codes, were randomized into the following 2 groups： group experiment ambroxol hydrochloride 150 mg and group control normal saline. The injection time of both group was 10 minutes after intu- bation. The HR,MAP,SpO2, PETCO2, the resistance of the airway（Raw）, the peak and plat airway pressure（Ppeak, Pplat） and pulmonary compliance（Compl） were monitored and recorded immediately before（T0 ） and at 5 （T1）, 30 （T2）, 60 （T3） min after drug injection and before extubation （T4）. Results Compared with To, Ppeak, Pplat at T1-T3 were increased significantly, Compl at T1-T4 was decreased ,and Raw at T2 was increased in both the groups（P〈0.05）. Compared with group control, the value of Ppeak and Pplat was lower at T2, T3, the Compl was higher at T2-T4, the Raw was low- er at T3 in experimental group（P〈0. 05）. Compared with To, HR and MAP at T1 was faster or high- er in both groups （P〈0.05）. There was no difference at other time point within group or between groups. Compared with To, PETCO2 showed an ascend trend but in the normal range at T1-T3 in both groups （P〈0.05）. The SpO2 showed no difference in both groups. Conclusion Application of ambr- oxol hydroehloride during gynecologic laparoscopie surgery in aged patients can improve the lung ven- tilation function, resulting in an increase in Compl and a decrease in Raw.