联合应用氨溴索和异丙托溴铵对老年肺癌患者肺叶切除术后肺功能的影响

Effect of perioperative treatment with ambroxol combined with ipratropium on pulmonary function in elderly patients with lung cancer undergoing lobectomy

目的探讨围手术期应用氨溴索联合异丙托溴铵雾化吸入对老年肺癌患者肺叶切除术后肺功能的影响。方法行肺叶切除术的老年肺癌患者120例随机均分为两组,在常规治疗的基础上,术前1周至术后1周每天分别给予盐酸氨溴索静脉滴注加异丙托溴铵雾化吸入(治疗组)或等容量生理盐水(对照组)。比较两组手术前后肺功能和血气分析变化,记录术后肺部并发症、ICU入住率、术后住院时间和总住院费用。结果两组患者术后第1秒用力呼气容积、用力肺活量、呼气峰值流速、动脉血氧分压和氧合指数均较术前下降(P<0.05),对照组下降幅度更大(P<0.05)。治疗组术后ICU入住率、住院时间和总住院费用均低于对照组(P<0.01)。与对照组比较,治疗组肺部并发症发生率低(P<0.01)。结论围手术期静脉滴注氨溴索加异丙托溴铵雾化吸入能有效改善老年肺癌患者术后肺功能,减少呼吸系统并发症发生,缩短住院时间,降低住院费用。

Objective To evaluate the influence of perioperative treatment with ambroxol combined with ipratropium on pulmonary function in the elderly with lung cancer undergoing lobectomy.Methods One hundred and twenty elderly patients undergoing lobectomy for lung cancer were randomly assigned into two groups with 60 cases each.During one week before operation to one week after surgery,the patients in group A were infused ambroxol 150 mg intravenously twice a day and atomizing inhalation of ipratropium 6 ml in normal saline 2 ml for 15 minutes twice a day.The patients in group B were given equal volume of normal saline instead of ambroxol and ipratropium as the controls.The pulmonary function tests and arterial blood gas analysis were compared between two groups.The incidence of postoperative pulmonary complications,enterance rate of ICU,postoperative hospital stay and total costs of hospital stay were recorded.Results The forced expiratory volume in 1 second,forced vital capacity,peak expiratory flow rate,PaO2 and oxygen index were significantly lowered on the 7 th day after operation compared to those before surgery in both groups（P〈0.05）,which were more in group B than those in group A.The postoperative enterance rate of ICU,hospital stay and total medical costs were all less in group A than those in group B（P〈0.05）.The incidence of postoperative pulmonary complications was lower in group A than that in group B（P〈0.01）.Conclusion Perioperative administration of ambroxol and ipratropium can effectively improve the postoperative lung function,reduce the pulmonary complications,shorten the postoperative hospital stay,and lower the total medical costs in the elderly with lung cancer undergoing lobectomy.