布地奈德联合异丙托溴铵雾化吸入对围手术期肺癌合并中重度COPD患者的临床应用研究

Protective effect of budesonide and ipratropium bromide inhalation during perioperative period in lung cancer patients complicated with COPD

目的研究布地奈德联合异丙托溴胺雾化吸入对肺癌合并中重度COPD患者,行胸腔镜肺叶切除围手术期肺功能保护的应用价值。方法将92例合并中重度COPD、拟接受胸腔镜肺叶切除术的患者随机分为两组,研究组患者围手术期给予布地奈德联合异丙托溴胺雾化吸入治疗并加常规基础治疗(氧疗、辅助排痰、呼吸康复训练),对照组患者接受常规治疗,观察并比较两组患者入院时、术前及术后的肺功能指标。结果研究组患者术前经持续3天的雾化治疗后,第一秒用力呼气量(FEV1%)、用力肺活量(FVC)、气道峰流速(PEF)及动脉氧分压(PaO2)均较入院时显著提高(74.59±12.22vs62.90±13.84,3.50±0.69vs2.98±0.88,52.11±5.50vs41.67±7.23,86.18±6.80vs73.21±8.38),两组术后PaO2下降,PaCO2升高,血气分析结果显示研究组术后指标优于对照组(78.67±6.06vs75.23±7.24,39.10±5.47vs41.88±5.16),差异均有统计学意义(P<0.05)。研究组术后痰上清液中炎症因子(IL-6、IL-8)水平显著低于术前和对照组术后(P<0.05),对照组手术前后IL-6和IL-8水平无统计学差异。实验组患者术后疼痛及肺部感染率均低于对照组,并显著减少了平均住院日。结论围手术期布地奈德联合异丙托溴胺雾化吸入可以有效保护肺癌合并COPD患者的肺功能,值得推广。

Objective To explore the protective pulmonary effect of budesonide and ipratropium bromide inhalation during perioperative period of patients with lung cancer and COPD.Methods A total of 92 patients underwent lobectomy were selected and randomly divided into two groups.The study group was given aerosol inhalation of budesonide and ipratropium bromide plus conventional therapy(oxygen therapy,auxiliary expectoration,respiratory rehabilitation)during perioperative period,while the control group was only given conventional therapy.Their pulmonary function were detected on admission,pro-and post-surgery.Results The levels of FEV 1%,FVC,PEF and PaO2 in the study group were significantly improved after 3 days inhalation therapy(74.59±12.22 vs 62.90±13.84,3.50±0.69 vs 2.98±0.88,52.11±5.50 vs 41.67±7.23,86.18±6.80 vs 73.21±8.38).The level of PaO2 decreased while the level of PaCO2 increased after video-assisted thoracoscopic lobectomy in the two groups.The blood gas analysis indicated the therapeutic efficacy was superior in the study group than in the control group(78.67±6.06 vs 75.23±7.24,39.10±5.47 vs 41.88±5.16).On the other hand,the concentration of IL-6 and IL-8 in sputum supernatant decreased obviously after surgery,while the control group was not(P<0.05).Moreover,the incidence of postoperative pain and pulmonary infection in the study group was significantly lower and the average duration of hospital stay was also shorter than those in the control group.Conclusion Budesonide and ipratropium bromide inhalation can effectively protect pulmonary function in lung cancer patients complicated with COPD after video-assisted thoracoscopic lobectomy.