浅谈沙丁胺醇预先给药对慢性阻塞性肺疾病患者腹腔镜手术呼吸力学影响
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论文导读:料由论文网www.7ctime.com提供,转载请保留地址.FiO2decreasedinT1-T3,T4rise,T0-T4statisticallysignificantfluctuationsduringtheperiod(P0.05),thecontrolgroupT1~T4Ppeak,Pplat,Raw,Complwerethereweresignificantfluctuations,Ppeak,Pplat,Rawweresignificantlyincreasedandthen
[摘要] 目的 探讨沙丁胺醇预先给药对慢性阻塞性肺疾病患者腹腔镜手术呼吸力学的影响。 策略 选择2012年3月~2013年5月在我院进行腹腔镜手术合并COPD患者50例,随机分为观察组和对照组各25例。观察组在麻醉诱导前先吸入硫酸沙丁胺醇气雾剂,对照组未给药,比较两组术前及术中血气分析和呼吸力学参数。 结果 观察组pH值和PaCO2值在T0~T4期间无显著波动(P>0.05),PaO2/FiO2在T1~T3下降,T4回升,T0~T4期间波动有统计学作用(P<0.05);对照组pH值、PaCO2值和PaO2/FiO2在T0~T4期间均存在显著波动(P<0.05),观察组T2、T3时pH值明显高于对照组,T2~T4 PaCO2值均显著低于对照组,T1~T4 PaO2/FiO2均显著高于对照组(P<0.05)。观察组T1~T4 Ppeak、Pplat、Raw有明显波动,均呈升高后降低(P0.05);对照组T1~T4 Ppeak、Pplat、Raw、Compl均有明显波动,Ppeak、Pplat、Raw呈显著升高后降低,Compl显著降低T4回升(P<0.05)。 结论 沙丁胺醇预先给药能够有效缓解慢性阻塞性肺疾病患者术中气道应激反应,抑制气道压力和阻力升高,增加肺顺应性,改善肺通气功能,有助于提高麻醉安全性。
[关键词] 慢性阻塞性肺疾病;沙丁胺醇;腹腔镜;呼吸力学
[] B [文章编号] 1673-9701(2013)34-0113-03
Impact of salbutamol pretreatment on chronic obstructive pulmonary disease respiratory mechanics of laparoscopic surgery
WU Yanhui1 CHEN Xinzhong2
1.Anesthesia Department, the First People's Hospital of Hangzhou, Hangzhou 310006, China; 2.Department of Anesthesiology, Affiliated Obstetrics and Gynecology Hospital of Medical College of Zhejiang University, Hangzhou 310006, China
[Abstract] Objective To study salbutamol pretreatment on chronic obstructive pulmonary disease respiratory mechanics of laparoscopic surgery. Methods March 2012 - May 2013 laparoscopic surgery in our hospital 50 patients with COPD were randomly divided into observation group and control group, 25 cases in the observation group before induction of anesthesia albuterol sulfate inhalation aerosol, control group, no treatment were compared preoperative and intraoperative blood gas analysis and respiratory mechanics parameters. Results The pH value and PaCO2 values T0 ~ T4 no significant fluctuations during the period (P > 0.05), PaO2/沙丁胺醇预先给药对慢性阻塞性肺疾病患者腹腔镜手术呼吸力学的影响论文资料由论文网www.7ctime.com提供,转载请保留地址.FiO2 decreased in T1-T3, T4 rise, T0-T4 statistically significant fluctuations during the period (P < 0.05), pH value of the control group, PaCO2 values and the PaO2/FiO2 at T0-T4 period there were significant fluctuations (P < 0.05), the observation group T2, T3 were significantly higher when the pH value, T2~T4 PaCO2 values were significantly lower than the control group, T1~T4 PaO2/FiO2 were significantly higher (P <0.05). Observation group T1~T4 Ppeak, Pplat, Raw significant fluctuations, showed increased and then decreased (P0.05), the control group T1~T4 Ppeak, Pplat, Raw, Compl were there were significant fluctuations, Ppeak, Pplat, Raw were significantly increased and then decreased, Compl rebounded significantly lower T4 (P < 0.05). Conclusion Salbutamol pretreatment can effectively alleviate the chronic obstructive pulmonary disease in patients undergoing airway stress response, inhibiting airway pressure and resistance increases, increased pulmonary compliance increased oxygen utilization, improve lung function, help to improve the anesthesia security.由专注毕业论文与职称论文的www.7ctime.com提供,转载请保留.本研究应用沙丁胺醇对气道高反应性的抑制作用,在麻醉诱导开始前进行预先给药,观察组在气管插管后气道压力和气道阻力均明显低于对照组,而由于对照组并未预先给药,患者在插管后出现了明显的气道应激反应,气道峰压、气道平台压和气道阻力均明显较观察组升高,同时出现了肺顺应性的明显降低,故PaCO2显著升高而 pH值和PaO2/FiO2显著降低。T1~T3的期间,由于插管后开始两组均出现了不同程度的支气管痉挛情况,气道压力和阻力均呈上升趋势,表明T1气管插管后气道受到刺激,并伴随麻醉药物的输入,呼吸作用逐渐受到抑制,T2气腹建立后胸廓运动性减弱,则导致支气管应激性增加,直至T3气腹建立30 min时,呈现PaCO2持续升高,pH值和PaO2/FiO2持续降低。而PaO2/FiO2降低被认为是COPD患者死亡的主要危险因素,并与死亡率呈正相关,其受到肺泡通气量、氧气浓度及血液循环效率的影响,能够反映患者对氧气的需求和供给的关系,体现呼吸作用对患者其他器官功能的影响[9,10]。COPD患者在麻醉和气腹持续过程中呈现的PaO2/FiO2持续降低,可视为对患者术中及术后恢复的主要不利因素,可能延长患者苏醒时间,增加术后烦躁或认知障碍的发生[11]。
但沙丁胺醇的预给药此时对观察组患者的支气管痉挛产生了较明显的抑制作用,气道峰压、气道平台压和气道阻力上升幅度较小,反观对照组则呈现大幅度的升高,气道内呼吸气流阻力明显增加,并伴随肺顺应性的持续性下降,肺通气明显减弱,出现类似急性肺损伤的症状。对照组患者PaO2/FiO2在T
[参考文献]
[1] Gregory D Kennedy,Victoria Rajamanickam,Erin S O'connor. Optimizing surgical care of colon cancer in the older adult population[J]. Annals of Surgery,2011,253(3):508-514.
[2] 李绍光,王晓伟,刘智. 合并慢性阻塞性肺疾病对老年髋部骨折患者术后病死率及功能恢复的影响[J]. 解放军医药杂志,2013,25(5):37-40.
[3] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2007年修订版)[J]. 中华内科杂志,2007,46(3):254-261.
[4] 周其富,蒋宗明,王海勇. 沙丁胺醇对慢性阻塞性肺疾病患者单肺通气时肺萎陷的影响[J]. 中国临床药理学与治疗学,2012,17(1):88-91.
[5] Amin S Herati,Sero Andonian,Soroush Rais-Bahrami. Use of the valveless trocar system reduces carbon dioxide absorption during laparoscopy when compared with standard trocars[J]. Urology,2011,77(5):1126-1132.
[6] 皮铎波,王志云,刘飞. 慢性阻塞沙丁胺醇预先给药对慢性阻塞性肺疾病患者腹腔镜手术呼吸力学的影响由提供海量免费论文范文的www.7ctime.com,希望对您的论文写作有帮助.性肺疾病患者外科手术硬膜外阻滞复合全身麻醉的临床应用[J]. 中国医师杂志,2012,14(9):1234-1236.
[7] Figen Atalay. Postoperative complications after abdominal surgery in pat ients with chronic obstructive pulmonary disease[J]. The Turkish Journal of Gastroenterology,2011,22(5):523-528.
[8] 江燕群. 沙丁胺醇与布地奈德雾化吸入在毛细支气管炎治疗中的应用研究[J]. 中国医刊,2013,48(6):59-60.
[9] 吴健华,陈志远,王玉珍,等. 不同机械通气模式用于慢性阻塞性肺疾病患者非开胸手术时通气效果的比较[J]. 中华麻醉学杂志,2011,31(12):1498-1499.
[10] 陆丹军,叶虹,韩威. 沙丁胺醇预吸入对全麻诱导中不同推注速度引发咳嗽反射的影响[J]. 中国实验诊断学,2013,17(2):324-326.
[11] Bird VG,Au JK,Sandman Y. Comparison of different extraction sites used during laparoscopic radical nephrectomy[J]. The Journal of Urology,2009,181(4):1565-1570.
[12] 王双武,王文豹,张燕,等. 沙丁胺醇联合异丙托溴铵吸入治疗慢性阻塞性肺疾病疗效观察[J]. 中国医药,2013,8(3):416.
(收稿日期:2013-09-06)
[摘要] 目的 探讨沙丁胺醇预先给药对慢性阻塞性肺疾病患者腹腔镜手术呼吸力学的影响。 策略 选择2012年3月~2013年5月在我院进行腹腔镜手术合并COPD患者50例,随机分为观察组和对照组各25例。观察组在麻醉诱导前先吸入硫酸沙丁胺醇气雾剂,对照组未给药,比较两组术前及术中血气分析和呼吸力学参数。 结果 观察组pH值和PaCO2值在T0~T4期间无显著波动(P>0.05),PaO2/FiO2在T1~T3下降,T4回升,T0~T4期间波动有统计学作用(P<0.05);对照组pH值、PaCO2值和PaO2/FiO2在T0~T4期间均存在显著波动(P<0.05),观察组T2、T3时pH值明显高于对照组,T2~T4 PaCO2值均显著低于对照组,T1~T4 PaO2/FiO2均显著高于对照组(P<0.05)。观察组T1~T4 Ppeak、Pplat、Raw有明显波动,均呈升高后降低(P0.05);对照组T1~T4 Ppeak、Pplat、Raw、Compl均有明显波动,Ppeak、Pplat、Raw呈显著升高后降低,Compl显著降低T4回升(P<0.05)。 结论 沙丁胺醇预先给药能够有效缓解慢性阻塞性肺疾病患者术中气道应激反应,抑制气道压力和阻力升高,增加肺顺应性,改善肺通气功能,有助于提高麻醉安全性。
[关键词] 慢性阻塞性肺疾病;沙丁胺醇;腹腔镜;呼吸力学
[] B [文章编号] 1673-9701(2013)34-0113-03
Impact of salbutamol pretreatment on chronic obstructive pulmonary disease respiratory mechanics of laparoscopic surgery
WU Yanhui1 CHEN Xinzhong2
1.Anesthesia Department, the First People's Hospital of Hangzhou, Hangzhou 310006, China; 2.Department of Anesthesiology, Affiliated Obstetrics and Gynecology Hospital of Medical College of Zhejiang University, Hangzhou 310006, China
[Abstract] Objective To study salbutamol pretreatment on chronic obstructive pulmonary disease respiratory mechanics of laparoscopic surgery. Methods March 2012 - May 2013 laparoscopic surgery in our hospital 50 patients with COPD were randomly divided into observation group and control group, 25 cases in the observation group before induction of anesthesia albuterol sulfate inhalation aerosol, control group, no treatment were compared preoperative and intraoperative blood gas analysis and respiratory mechanics parameters. Results The pH value and PaCO2 values T0 ~ T4 no significant fluctuations during the period (P > 0.05), PaO2/沙丁胺醇预先给药对慢性阻塞性肺疾病患者腹腔镜手术呼吸力学的影响论文资料由论文网www.7ctime.com提供,转载请保留地址.FiO2 decreased in T1-T3, T4 rise, T0-T4 statistically significant fluctuations during the period (P < 0.05), pH value of the control group, PaCO2 values and the PaO2/FiO2 at T0-T4 period there were significant fluctuations (P < 0.05), the observation group T2, T3 were significantly higher when the pH value, T2~T4 PaCO2 values were significantly lower than the control group, T1~T4 PaO2/FiO2 were significantly higher (P <0.05). Observation group T1~T4 Ppeak, Pplat, Raw significant fluctuations, showed increased and then decreased (P0.05), the control group T1~T4 Ppeak, Pplat, Raw, Compl were there were significant fluctuations, Ppeak, Pplat, Raw were significantly increased and then decreased, Compl rebounded significantly lower T4 (P < 0.05). Conclusion Salbutamol pretreatment can effectively alleviate the chronic obstructive pulmonary disease in patients undergoing airway stress response, inhibiting airway pressure and resistance increases, increased pulmonary compliance increased oxygen utilization, improve lung function, help to improve the anesthesia security.由专注毕业论文与职称论文的www.7ctime.com提供,转载请保留.本研究应用沙丁胺醇对气道高反应性的抑制作用,在麻醉诱导开始前进行预先给药,观察组在气管插管后气道压力和气道阻力均明显低于对照组,而由于对照组并未预先给药,患者在插管后出现了明显的气道应激反应,气道峰压、气道平台压和气道阻力均明显较观察组升高,同时出现了肺顺应性的明显降低,故PaCO2显著升高而 pH值和PaO2/FiO2显著降低。T1~T3的期间,由于插管后开始两组均出现了不同程度的支气管痉挛情况,气道压力和阻力均呈上升趋势,表明T1气管插管后气道受到刺激,并伴随麻醉药物的输入,呼吸作用逐渐受到抑制,T2气腹建立后胸廓运动性减弱,则导致支气管应激性增加,直至T3气腹建立30 min时,呈现PaCO2持续升高,pH值和PaO2/FiO2持续降低。而PaO2/FiO2降低被认为是COPD患者死亡的主要危险因素,并与死亡率呈正相关,其受到肺泡通气量、氧气浓度及血液循环效率的影响,能够反映患者对氧气的需求和供给的关系,体现呼吸作用对患者其他器官功能的影响[9,10]。COPD患者在麻醉和气腹持续过程中呈现的PaO2/FiO2持续降低,可视为对患者术中及术后恢复的主要不利因素,可能延长患者苏醒时间,增加术后烦躁或认知障碍的发生[11]。
但沙丁胺醇的预给药此时对观察组患者的支气管痉挛产生了较明显的抑制作用,气道峰压、气道平台压和气道阻力上升幅度较小,反观对照组则呈现大幅度的升高,气道内呼吸气流阻力明显增加,并伴随肺顺应性的持续性下降,肺通气明显减弱,出现类似急性肺损伤的症状。对照组患者PaO2/FiO2在T
2、T3时出现明显下降,均值论文导读:
低于300。沙丁胺醇起效快,药效持续时间能达到5~6 h,故在本研究的腹腔镜手术中持续发挥对支气管痉挛的抑制作用,从T1开始观察组的气道压力和阻力上升幅度均低于对照组。而由于沙丁胺醇的持续效应,可能对患者术后拔管引起的刺激也能产生明显的抗痉挛作用,改善患者术后预后,降低COPD发作的风险[12]。由于沙丁胺醇给药方式简单,吸入后直接作用于气管、支气管和肺部靶器官,准确性高,操作简便,有较强的可操作性,5 min后就能发挥对气道平滑肌的解痉、抗炎反应和降低气道血管通透性、消除水肿、减少分泌物及推动气道黏膜纤毛清除能力的作用,在面罩吸氧前预给药则能在麻醉诱导前即刻提供气道保护,从而改善由于麻醉和气腹引起的气道高反应性,改善肺功能。提示沙丁胺醇预先给药能够有效缓解慢性阻塞性肺疾病患者术中气道应激反应,抑制气道压力和阻力升高,增加肺顺应性,增加氧气利用率,改善肺通气功能,有助于提高麻醉安全性。[参考文献]
[1] Gregory D Kennedy,Victoria Rajamanickam,Erin S O'connor. Optimizing surgical care of colon cancer in the older adult population[J]. Annals of Surgery,2011,253(3):508-514.
[2] 李绍光,王晓伟,刘智. 合并慢性阻塞性肺疾病对老年髋部骨折患者术后病死率及功能恢复的影响[J]. 解放军医药杂志,2013,25(5):37-40.
[3] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2007年修订版)[J]. 中华内科杂志,2007,46(3):254-261.
[4] 周其富,蒋宗明,王海勇. 沙丁胺醇对慢性阻塞性肺疾病患者单肺通气时肺萎陷的影响[J]. 中国临床药理学与治疗学,2012,17(1):88-91.
[5] Amin S Herati,Sero Andonian,Soroush Rais-Bahrami. Use of the valveless trocar system reduces carbon dioxide absorption during laparoscopy when compared with standard trocars[J]. Urology,2011,77(5):1126-1132.
[6] 皮铎波,王志云,刘飞. 慢性阻塞沙丁胺醇预先给药对慢性阻塞性肺疾病患者腹腔镜手术呼吸力学的影响由提供海量免费论文范文的www.7ctime.com,希望对您的论文写作有帮助.性肺疾病患者外科手术硬膜外阻滞复合全身麻醉的临床应用[J]. 中国医师杂志,2012,14(9):1234-1236.
[7] Figen Atalay. Postoperative complications after abdominal surgery in pat ients with chronic obstructive pulmonary disease[J]. The Turkish Journal of Gastroenterology,2011,22(5):523-528.
[8] 江燕群. 沙丁胺醇与布地奈德雾化吸入在毛细支气管炎治疗中的应用研究[J]. 中国医刊,2013,48(6):59-60.
[9] 吴健华,陈志远,王玉珍,等. 不同机械通气模式用于慢性阻塞性肺疾病患者非开胸手术时通气效果的比较[J]. 中华麻醉学杂志,2011,31(12):1498-1499.
[10] 陆丹军,叶虹,韩威. 沙丁胺醇预吸入对全麻诱导中不同推注速度引发咳嗽反射的影响[J]. 中国实验诊断学,2013,17(2):324-326.
[11] Bird VG,Au JK,Sandman Y. Comparison of different extraction sites used during laparoscopic radical nephrectomy[J]. The Journal of Urology,2009,181(4):1565-1570.
[12] 王双武,王文豹,张燕,等. 沙丁胺醇联合异丙托溴铵吸入治疗慢性阻塞性肺疾病疗效观察[J]. 中国医药,2013,8(3):416.
(收稿日期:2013-09-06)