盐酸氨溴索减少血气胸术后肺部并发症及对肺保护作用

The role of ambroxol hydrochloride in reducing hemopneumothorax and postoperative pulmonary complications and its lung protective effect

目的探讨术前给予盐酸氨溴索对于减少血气胸胸腔镜手术患者术后并发症的发生率及对肺保护作用的临床价值。方法选取2013年5月-2016年4月在北京燕化医院胸心外科接受胸腔镜手术治疗的69例外伤性血气胸胸腔镜手术患者进行回顾性分析,研究组36例患者术前预防性的应用盐酸氨溴索＋基础治疗,对照组33例仅给予基础治疗（吸氧、止血、止痛、补液、抗炎、预防应激反应）,对比2组患者的手术并发症、术后血气等指标。结果研究组的肺部感染、肺不张发生率、住院时间、住院总费用显著低于对照组（P〈0.05）;研究组术后3d的PaO2、氧合指数显著高于对照组（P〈0.05）,PaCO2水平显著低于对照组（P〈0.05）;术后1 d,研究组的肺表面活性物质相关蛋白（surfactant protein A,SP-A）、丙二醛（malondialdehyde,MDA）显著低于对照组（P〈0.05）,术后3 d,研究组的降钙素原（procalcitonin,PCT）、SP-A、细胞间黏附分子（intercellular adhesion molecule-1,ICAM-1）、MDA显著低于对照组（P〈0.05）;术后3 d,研究组患者的外周血中超氧化物歧化酶（superoxide dismutase,SOD）水平显著高于对照组（P〈0.05）。结论术前给予盐酸氨溴索能够减少血气胸胸腔镜手术患者术后并发症,同时对患者肺具有一定保护作用。

Objective To explore the preoperative administration of ambroxol hydrochloride for decreasing complications in hemopneumothorax patients undergoing thoracic surgery and the lung protective effect of clinical value. Methods 69 cases traumatic hemopneumothorax undergoing thoracic surgery selected from May 2013 to April 2016 in our hospital were retrospectively analyzed,study group of 36 cases preoperative administered ambroxol hydrochloride plus basic treatment research,the control group of 33 cases only received basic treatment（oxygen,hemostasis,pain relief,fluid infusion,anti-inflammation,prevention of stress response）,the complications and postoperative blood gas indicators were compared between two groups.Results The lung infection,complications,atelectasis,hospitalization and total cost in study group were significantly lower than those in control group（P 〈0. 05）,the PaO2,and oxygenation index in study group post-surgery 3 days was higher than those in control group（P 〈0. 05）,while PaCO2 was lower than that in control group（P 〈0. 05）. The surfactant protein A（SP-A） and malondialdehyde（MDA） post-surgery 1 day in study group were lower than those in control group（P 〈0. 05）,the procalcitonin（PCT）,SP-A,intercellular adhesion molecule-1（ICAM-1） and MDA post-surgery 3 day in study group were lower than those in control group（P 〈0. 05）. The superoxide dismutase（SOD） post-surgery 3 day in study group was higher than that in control group（P 〈0. 05）. Conclusion Preoperative application of ambroxol hydrochloride could reduce postoperative complications of patients undergoing thoracic surgery,and has lung protective effect.