术前雾化吸入盐酸戊乙奎醚对心肺转流心脏瓣膜置换术患者肺损伤的保护作用

Protective effect of preoperative aerosol inhalation of penehyclidine hydrochloride on lung injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass

目的观察术前雾化吸入盐酸戊乙奎醚(PHC)对心肺转流(CPB)心脏瓣膜置换术患者肺损伤的保护作用。方法90例择期行CPB心脏瓣膜置换术的患者随机分为PHC雾化组、PHC静脉组和对照组,每组30例。PHC雾化组于麻醉诱导前30min给予PHC 0.5mg雾化吸入,PHC静脉组给予PHC 0.5mg静脉注射,对照组给予等容量生理盐水静脉注射。分别于CPB开始前(T0)、CPB开始后30min(T1)、术毕(T2)和术后24h(T3)时检测各组呼吸指数(RI)、氧合指数(OI)和血清炎症因子水平。结果T0时,三组患者RI、OI和血清IL-8、TNF-α水平比较差异均无统计学意义(P>0.05)。T1~T3时,PHC雾化组RI和血清IL-8、TNF-α水平低于PHC静脉组和对照组(P<0.05)。PHC雾化组T1、T2时OI高于PHC静脉组和对照组(P<0.05),T3时高于对照组(P<0.05)。结论与静脉给药相比,术前雾化吸入PHC对CPB心脏瓣膜置换术患者肺损伤有明显的保护作用,能有效改善氧合及肺功能,减轻炎症反应。

Objective To observe the protective effect of preoperative aerosol inhalation of penehyclidine hydrochloride(PHC)on the lung injury in the patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Ninety patients undergoing cardiac valve replacement under CPB were randomly divided into three groups with 30cases each.At 30minutes before anesthesia induction,group A was given PHC 0.5mg aerosol inhalation,group B was given PHC 0.5mg intravenous injection,and group C was given equal volume normal saline intravenous injection.Respiratory index(RI),oxygenation index(OI)and serum inflammatory factors were measured before CPB(T0),30minutes after CPB(T1),the end of operation(T2)and 24 hours after operation(T3).Results At T0,there were no significant differences in RI,OI and serum levels of IL-8 and TNF-αamong the three groups(P>0.05).From T1 to T3,RI and serum levels of IL-8 and TNF-αin group A were lower than those in groups of B and C(P<0.05).OI in group A was higher than that in groups of B and C at T1 and T2(P<0.05),and higher than that in group C at T3(P<0.05).Conclusion Compared with intravenous administration,preoperative aerosol inhalation of PHC has a better protective effect on the lung injury in the patients undergoing cardiac valve replacement under CPB,which can effectively improve oxygenation and lung function,and relieve inflammatory response.