乌司他丁对轻度阻塞性通气功能障碍老年患者腹腔镜胆囊切除手术时肺功能的影响

Effect of ulinastatin on pulmonary function during laparoscopic cholecystectomy for elderly patients with mild obstructive ventilation dysfunction

目的评价乌司他丁对轻度慢性阻塞性通气功能障碍(COPD)老年患者腹腔镜胆囊切除手术(LC)时肺功能的影响。方法择期全身麻醉下行LC患者100例,年龄65~75岁,术前肺功能检查提示合并有轻度COPD。采用随机数字表法将患者分为乌司他丁组(UTI组)和对照组(C组),各50例。UTI组切皮前30 min静脉输注乌司他丁0.5×104 U/kg,C组给予等容量生理盐水。于气管插管术后5 min(气腹前)(T1)、关气腹前即刻(T2)、气腹结束后10 min(T3)记录气道峰压(Ppeak)、平均气道压(Pmean)、气道平台压(Pplat)、呼气末正压(PEEP),根据公式计算驱动压(DP)。采集桡动脉血样行血气分析,记录PaO2和PaCO2,根据公式计算肺泡-动脉血氧分压差(A-aDO2)、氧合指数(PaO2/FiO2)、呼吸指数(RI)和死腔通气率(VD/VT)。记录拔除气管导管时间、拔管后48 h内高碳酸血症、低氧血症、新出现肺部啰音等并发症的发生情况。结果与C组比较,UTI组T1~3时Ppeak、Pmean、DP、RI、VD/VT和A-aDO2均降低,PaO2/FiO2升高,术后拔管时间缩短,48 h内低氧血症发生率和新出现肺部啰音发生率均降低(均P<0.05);与T1、T3时比较,C组和UTI组T2时Ppeak、Pmean、DP、RI、VD/VT和A-aDO2均升高,PaO2/FiO2降低(均P<0.05)。结论乌司他丁可改善合并轻度阻塞性通气功能障碍老年患者腹腔镜胆囊切除手术时肺功能。

Objective To evaluate the effect of ulinastatin on pulmonary function during laparoscopic cholecystectomy(LC)for elderly patients with mild pulmonary dysfunction.Methods A total of 65 to 75 years old 100 patients with mild obstructive ventilation dysfunction undergoing elective LC were randomly divided into a control group(group C)and an ulinastatin group(group UTI),with 50 cases in each group.Group UTI were intravenously infused with ulinastatin 0.5×104 U/kg 30 min before incision,and group C with the equal volume of normal saline.The airway peak pressure(Ppeak),mean airway pressure(Pmean),airway plateau pressure(Pplat),and positive end-expiratory pressure(PEEP)were measured 5 min after intubation(before pneumoperitoneum)(T1),at the end of pneumoperjtoneum(T2),and 10 min after the end of pneumoperitoneum(T3).The driving pressure was calculated.Arterial blood samples were obtained at Tl,T2,and T3 for blood gas analysis,and the PaO2 and PaCO2 were recorded.The alveolar-arterial oxygen partial pressure difference(A-aDO2),oxygenation index(PaO2/FiO2),respiratory index(RI),and physiologic dead space fraction(VD/VT)were calculated.The time to remove tracheal tube and the occurrence of complications such as hypercapnia,hypoxemia,and new lung vocalization within 48 hours after extubation were recorded.Results The Ppeak,Pmean,DP,RI,VD/VT,and A-aDO2,as well as the incidences of hypoxemia and new lung snoring within 48 h,were lower,the PaO2/FiO2 was higher,and the postoperative extubation time was shorter in group UTI than in group C(all P<0.05).Compared with those at T1 and T3,the Ppeak,Pmean,DP,RI,VD/VT,and A-aDO2 at T1 were higher and the PaO2/FiO2 was lower in both groups(all P<0.05).Conclusion Ulinastatin can improve pulmonary function during laparoscopic surgery in elderly patients with mild obstructive ventilation dysfunction.