行胸腔镜手术的老年肺癌患者围手术期应用爱全乐联合沐舒坦的疗效-现代医学

行胸腔镜手术的老年肺癌患者围手术期应用爱全乐联合沐舒坦的疗效

单位：广州番禺中心医院胸外科, 广东广州 510000

分类号：R734.2

出版年·卷·期（页码）：2020·39·第四期（475-480）

摘要：

目的：分析胸腔镜下老年肺癌手术患者围手术期应用爱全乐雾化吸入联合沐舒坦静脉滴注对动脉血气指标、肺功能及炎性因子的影响。方法：选取本院2015年8月至2017年8月择期开展胸腔镜手术治疗的老年（>60岁）肺癌病患72例，采用随机数字表法将患者分为观察组和对照组两组，各36例，观察组围手术期给予爱全乐雾化吸入联合沐舒坦静脉滴注治疗，对照组围手术期给予等量生理盐水补充。对比两组术前、术后5d动脉血气[动脉氧分压（PaO₂）、血酸碱值（pH）、氧饱和度（SaO₂）、动脉血二氧化碳分压（PaCO₂）]，肺功能[第1秒用力呼气量（FEV₁）、每分钟最大通气量（MVV）、第1秒用力呼气量占用力肺活量比值（FEV₁/FVC）]，炎性因子[肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6、C反应蛋白（CRP）]，记录呼吸系统并发症。结果：观察组术后机械通气时间、ICU观察时间、住院时间以及术后5 d的痰液性质、痰液性状及咳嗽难易度均明显低于对照组（P<0.05）。观察组术后5d PaO₂、FEV₁、MVV、FEV₁/FVC水平均明显高于对照组（P<0.05）。观察组术后5d TNF-α、IL-6、CRP水平及呼吸系统并发症、ICU再入率显著低于对照组（P<0.05）。结论：实施爱全乐雾化吸入联合沐舒坦静脉滴注对胸腔镜下老年肺癌手术患者围手术期干预可有效改善患者肺功能、促进动脉血氧恢复、减轻炎症反应、减少术后并发症。

Objective: To analyze the effect of ipratropium inhalation combined with ambroxol intravenous drip on arterial blood gas, pulmonary function and inflammatory factors on the elderly patients with lung cancer undergo the thoracoscopic surgery. Methods: 72 elderly patients (>60 years) with lung cancer who undergo the thoracoscopy surgery in our hospital from August 2015 to August 2017 were selected and divided into two groups by a random number table method, each with 36 patients.The observation group was given perioperative ipratropium inhalation combined with ambroxol intravenous drip, while the control group was received nutritional therapy, anti-infection, perioperative nursing guidance and equal saline supplementation. The arterial blood gas[arterial partial pressure of oxygen(PaO₂), blood pH(pH), oxygen saturation(SaO₂), arterial partial pressure of carbon dioxide(PaCO₂)], pulmonary function[Forced expiratory volume in one second(FEV₁), maximal voluntary ventication(MVV), ratio of FEV₁ and forced vital capacity (FEV₁/FVC), and inflammatory factor[tumor necrosis factor-α(TNF-α), Interleukin-6(IL-6), C-reactive protein(CRP)] were compared between two groups before and 5 days after operation. Respiratory complications were recorded.Results: The time of mechanical ventilation after operation was significantly lower in the observation group than that in the control group (P<0.05). The observation time, hospitalization time, sputum viscosity, purulent state and cough difficulty were significantly lower in the observation group than in the control group (P<0.05). The levels of FEV₁/FVC in the observation group were significantly higher than those in the control group on the 5th day after operation (P<0.05). The level of TNF-α, IL-6, CRP and the reentry rate of respiratory complications in the observation group were significantly lower than those in the control group 5 days after operation (P<0.05).Conclusion: The perioperative intervention of ipratropium inhalation combined with ambroxol intravenous drip in elderly patients with lung cancer under thoracoscopic surgery can effectively improve the pulmonary function, promote the recovery of arterial blood oxygen, alleviate inflammatory reaction and reduce complications.

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