围术期应用氨溴索对老年肺癌患者肺保护作用的研究

Lung-protective effect of perioperative treatment with Ambroxol in the elderly lung cancer patients

目的探讨围术期应用氨溴索对老年肺癌患者肺叶切除术后肺功能、肺部并发症、术后住院时间和总住院费用的影响。方法选取行肺叶切除术的老年肺癌患者140例，随机分为对照组（70例）和氨溴索治疗组（70例）。对照组术后给予胸科标准化治疗，治疗组在胸科标准化治疗基础上，手术当日至术后5d静脉给予氨溴索注射液90mg，1次／8h。采集并比较两组术前一般资料、术中情况、手术前后的肺功能和血气分析结果、术后肺部并发症、ICU入住率、术后住院时间和总住院费用。结果两组术前一般资料、术中情况具有可比性。氨溴索治疗组和对照组在手术后，第1秒用力呼气容积（FEV1）、用力肺活量（FVC）、呼气峰值流速（PEF）、动脉血氧分压较手术前均有下降；而空白对照组比氨溴索治疗组的下降更明显（均P〈0．05）。与对照组相比，氨溴索治疗组肺部并发症明显减少，氧合指数显著改善；术后ICU入住率、住院时间、总住院费用均显著低于对照组（均P〈O．05）。结论围术期应用氨溴索能够有效降低老年肺癌患者开胸术后肺部并发症，改善肺功能、降低住院费用，缩短临床住院时间，促进患者术后快速康复，临床值得推广应用。

Objective To investigate the influence of perioperative administration of Ambroxol on pulmonary function, postoperative complications, postoperative hospital-stay and cost in elderly lung cancer patients after thoracic lobectomy surgery. Methods One hundred and forty consecutive elderly patients who underwent thoracic lobectomy surgery for lung cancer were randomly assigned into 2 groups： control group （n=70） and Ambroxol group （n= 70）. In control group, subjects were given the standardized treatment. In the Ambroxol group, patients were given the standardized treatment plus Ambroxol （90 rag/q, 8 h/d） from the day of operation to postoperative 5 days. The preoperative general information, intraoperative conditions, pulmonary function tests, arterial blood gases, incidence of perioperative morbidity, duration of ICU stay, length and costs of postoperative hospital-stay were collected and compared between the 2 groups. Results The 2 groups were well matched for demographics and operative variables. The forced expiratory volume in 1 second （FEV1）, the forced vital capacity （FVC）, peak expiratory flow rate （PEF） and arterial oxygen pressure were reduced in the 2 groups after operation as compared with before treatment, while the decreases of the above indexes were more significant in the control group than in the Ambroxol group （P〈0.05）. Compared with the control group, the postoperative pulmonary complications declined, oxygenation index improved, the postoperative ICU occupancy rate and the length and costs of postoperative hospital-stay were decreased in the ambroxol group （all P〈0.05）. Conclusions Perioperative administration of Ambroxol could reduce the incidence of pulmonary complications, improve the lung function, decrease the total hospitalization cost, shorten the length of hospital-stay, promote a rapid recovery after surgery, which is worthy of clinical application.