雾化吸入在围手术期的应用现状及研究进展

Current Status and Research Progress of Nebulized Inhalation in the Perioperative Period

重点介绍4种围术期雾化吸入联合用药方案及其临床应用范畴与效果,认为三联或多重雾化吸入临床应用尚缺乏循证医学依据,三联或多重雾化吸入后每一种雾化吸入药物颗粒直径、释雾量、沉积效率需要深入研究。分析术前雾化吸入、术中雾化吸入和术后早期雾化吸入各自的优缺点,分别对术中雾化吸入装置的“植入”方法、麻醉呼吸机参数的设定、提高术中雾化吸入效果的方法提出建议。归纳指出目前尚缺乏统一的术中雾化吸入效果评价标准。提出不同的吸入麻醉药与雾化吸入药的协同作用、椎管内麻醉(交感神经阻滞)对雾化吸入的影响是术中雾化吸入谮需解决的课题;分析表明,围术期雾化吸入在老年髋部骨折手术患者“快速康复外科”实践中应用前景光明。

The four combined perioperative nebulized inhalation regimens and their clinical application scope and effects are highlighted.It is believed that the clinical application of triple or multiple nebulized inhalation still lacks evidence-based medical basis,and the particle diameter,mist release volume,and deposition efficiency of each nebulized inhalation drug after triple or multiple nebulized inhalation need to be studied in depth.The advantages and disadvantages of preoperative nebulizer inhalation,intraoperative nebulizer inhalation and early postoperative nebulizer inhalation were analyzed,and suggestions were made on the method of“implantation”of intraoperative nebulizer inhalation device,the setting of anesthesia ventilator parameters,and the methods to improve the effect of intraoperative nebulizer inhalation,respectively.It is summarized that there is no unified standard for evaluating the effect of intraoperative nebulized inhalation.It is proposed that the synergistic effect of different inhaled anesthetics and nebulized inhalation drugs and the effect of intravertebral anesthesia(sympathetic block)on nebulized inhalation are urgent topics to be addressed in intraoperative nebulized inhalation.The analysis shows that perioperative nebulized inhalation has a bright future in the practice of“rapid rehabilitation surgery”for elderly hip fracture patients.