负压封闭引流联合皮质激素雾化吸入预防肝切除患者术后肺部感染的效果观察

Effect of vacuum sealing drainage combined with aerosol inhalation of corticosteroid on prevention of pulmonary infection after hepatectomy

目的研究负压封闭引流联合内皮质激素雾化吸入预防肝切除术后肺部感染的应用效果。方法选取2014年1月-2017年1月在医院接受肝切除术治疗的240例患者作为研究对象,根据随机数表法分为两组,每组各120例;对照组患者在肝切除术后1d给予雾化吸入布地奈德、氨溴索,治疗7d;研究组患者在对照组治疗基础上开展负压封闭引流方式进行治疗,7d/疗程,比较两组患者治疗前后动脉血气指标、疼痛程度变化及肺部感染发生率。结果治疗后两组患者血氧分压(PaO_2)、氧合指数(OI)、血氧饱和度(SaO_2)水平均高于治疗前,肺泡-动脉血氧梯度(A-aDO_2)水平均低于治疗前(P<0.05),且研究组指标变化幅度优于对照组(P<0.05);两组患者疼痛评分均低于治疗前(P<0.05),且研究组疼痛评分下降幅度优于对照组(P<0.05);治疗后研究组患者肺部感染率5.8%低于对照组的15.0%,差异有统计学意义(χ2=5.403,P=0.046)。结论针对肝切除手术患者而言,采用负压封闭引流联合内皮质激素雾化吸入治疗能有效减轻疼痛,减少肺部感染发生率,改善肺部通气情况,临床应用效果显著,值得推广应用。

OBJECTIVE To explore the effect of vacuum sealing drainage（VSD）combined with aerosol inhalation of corticosteroid on prevention of pulmonary infection after hepatectomy.METHODS A total of 240 patients who received the hepatectomy in the hospital from Jan 2014 to Jan 2017 were recruited as the study objects and randomly divided into two groups,with 120 cases in each group.The control group was given aerosol inhalation of budesonide and ambroxol for 7 days one day after the hepatectomy,while the study group was treated with additional VSD on basis of the treatment of the control group,7 days as a treatment course.The arterial blood gas indexes,degree of pain and incidence of pulmonary infection were observed and compared between the two groups of patients.RESULTS The levels of partial pressure of blood oxygen（PaO2）,oxygenation index（QI）and oxyhemoglobin saturation（SaO2）of the two groups of patients were higher after the treatment than before the treatment,and the alveolar-arterial oxygen gradient（A-aDO2）level was lower after the treatment than before the treatment（P〈0.05）,and the indexes changed more significantly in the study group than in the control group（P〈0.05）.The pain scores of the two groups of patients were significantly lower after the treatment than before the treatment（P〈0.05）,and the pain score was reduced more significantly in the study group than in the control group（P〈0.05）.The incidence rate of pulmonary infection was 5.8% in the study group after the treatment,significantly lower than 15.0%in the control group（χ2=5.403,P〈0.05）.CONCLUSIONThe VSD combined with aerosol inhalation of corticosteroid can effectively alleviate the pain of the patients undergoing the hepatectomy,reduce the incidence of pulmonary infection and improve the pulmonary ventilation,with the clinical effect remarkable,and it is worthy to be promoted in the hospital.