氨茶碱在慢性阻塞性肺疾病患者上腹部手术全身麻醉中的作用

Role of aminophylline in COPD patients undergoing abdominal surgery under general anesthesia

目的 探讨氨茶碱在慢性阻塞性肺疾病患者上腹部手术全身麻醉中的作用.方法 选取行全身麻醉上腹部手术且合并慢性阻塞性肺疾病的患者60例,采用随机数字表法分为氨茶碱治疗组（n=30）及对照组（n=30）,气管插管后,氨茶碱治疗组给予静脉注射氨茶碱（2 mg/kg）,对照组给予等量0.9%氯化钠注射液,观察两组呼吸力学、血清炎性因子、麻醉苏醒时间及心血管不良反应发生情况.结果 两组一般情况（性别、年龄、体质量、吸烟状况、肺功能、慢性阻塞性肺疾病分级、手术部位、手术时间及麻醉时间）差异无统计学意义.在呼吸力学方面,全身麻醉过程中茶碱的应用可以降低气道峰压（15 min,t=9.220,P=0.047）、气道平台压（15 min,t=5.906,P=0.025）及气道阻力（15 min,t=10.438,P=0.04）,改善肺顺应性（15 min,t=-7.431,P=0.001）;氨茶碱可以降低全身麻醉手术过程中肿瘤坏死因子α（8 h,t=6.374,P=0.000）、白介素8（8 h,t=7.716,P=0.000）和超敏C反应蛋白（8 h,t=6.665,P=0.000）,缩短麻醉术后恢复自主呼吸（t=3.439,P=0.001）、睁眼（t=3.516,P=0.001）、四肢活动（t=6.249,P=0.000）及拔除气管插管（t=3.159,P=0.003）的时间,同时,氨茶碱的应用对血压及心率无明显不良影响.结论 在慢性阻塞性肺疾病患者行上腹部手术全身麻醉中,氨茶碱的应用可以改善患者呼吸力学参数,减少炎性因子的升高,促进麻醉术后的苏醒,且无明显心血管不良反应,值得推广应用.

Objective To study the role of aminophylline in COPD patients undergoing abdominal surgery under general anesthesia.Methods A total of 60 COPD patients who received the upper abdominal surgery under general anesthesia were randomly assigned as regular treatment group （control,n=30） and aminophylline group （aminophylline,n=30）.The aminophylline group was intravenously injected aminophylline （2mg/kg） after intubation,and the same volume of saline was injected for the control group.The respiratory mechanics,serum cytokines including tumor necrosis factor-α（TNF-α）,interleukin-8 （IL-8） and interleukin-10（IL-10）,recovery time and adverse cardiovascular events were measured.Results The general conditions,including gender,age,weight,smoking status,lung function,GOLD standard,surgical site,operation time and anesthetic time had no statistically significant differences between the two groups.During general anesthesia,aminophylline decreased the peak airway pressure（15 minutes,t=9.220,P=0.047）,the plate airway pressure（15 minutes,t=5.906,P=0.025） and the airway resistance（15 minutes,t=10.438,P=0.04）.Aminophylline increased the respiratory compliance（15 minutes,t=-7.431,P=0.001）.Aminophylline attenuated the increase of inflammatory cytokines,such as TNF-α（8 hours,t=6.374,P=0.000）,IL-8（8 hours,t=7.716,P=0.000） and hsCRP（8 hours,t=6.665,P=0.000）.Aminophylline shortened the time to spontaneous ventilation（t=3.439,P=0.001）,opening eyes（t=3.516,P=0.001）,limb movement（t=6.249,P=0.000） and extubation （t=3.159,P=0.003）.Administration of aminophylline had no obvious adverse effects on blood pressure and heart rate.Conclusion Administration of aminophylline for COPD patients undergoing abdominal surgery under general anesthesia can improve respiratory mechanics,downregulate inflammatory cytokines,accelerate recovery after general anesthesia and possess no obvious adverse cardiovascular effects,which is worthy of popularization.