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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2007, Vol. 01 ›› Issue (02) : 118 -121. doi: 10.3877/cma.j.issn.1674-0793.2007.02.015

临床护理

不同雾化吸入方案对气管内麻醉下上腹部手术后气道炎症反应的影响
廖培娇1, 许红璐1, 雷阳阳1, 李尚琴1   
  1. 1.510080 广州市中山大学附属第一医院肝胆外科
  • 出版日期:2007-02-01

The Influence of Differrent Inhalation Methods on the Postoperative Airway Inflammation in Patients Who Underwent Upper Abdominal Surgery Under Bronchial Anaesthesia

Pei-jiao Liao, Hong-lu Xu, Yang-yang Lei, Shangqin Li   

  • Published:2007-02-01
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廖培娇, 许红璐, 雷阳阳, 李尚琴. 不同雾化吸入方案对气管内麻醉下上腹部手术后气道炎症反应的影响[J/OL]. 中华普通外科学文献(电子版), 2007, 01(02): 118-121.

Pei-jiao Liao, Hong-lu Xu, Yang-yang Lei, Shangqin Li. The Influence of Differrent Inhalation Methods on the Postoperative Airway Inflammation in Patients Who Underwent Upper Abdominal Surgery Under Bronchial Anaesthesia[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2007, 01(02): 118-121.

目的

探讨不同雾化吸入方案对气管内麻醉上腹部术后病人气道炎症反应的影响。

方法

60例病人随机分为实验组和对照组,对照组采用“喷喉方”雾化吸入,实验组采用“布地奈德”进行雾化吸入。不同时间点分别收集病人痰液、血液,检测痰液中炎症反应指标IL-8和TNF-α的水平,并检测血液中炎性细胞的总数和比例。对病人每日的咳嗽、咳痰症状进行评分,并详细记录每日体温变化。统计两组病人的术后肺部并发症发生情况。

结果

两组病人术后体温、血液细胞计数变化无显著差异(P>0.05)。术后痰液中IL-8、TNF-α水平较术前显著增高(P<0.05),术后第4天实验组两者均降至术前水平,而对照组未明显下降。同时间点比较,实验组较对照组水平低(P<0.05)。实验组在痰液量、咳嗽、咳痰症状改善方面优于对照组。

结论

采用“布地奈德”雾化吸入在改善上腹部术后病人术后咳嗽、咳痰症状,减轻术后气道炎症反应方面具有显著疗效,建议临床推广应用。

关键词: 雾化吸入, 气道炎症, 上腹部手术, 气管内麻

Objective

To investigate the influence of differrent inhalation methods on the postoperative airway inflammation in patients who underwent upper abdominal surgery under bronchial anaesthesia.

Methods

Sixty patients who underwent surgery at our institute were enrolled and randomly assigned the experimental group and the control group.Budesonide was inhaled by patients in the experimental group propelled by high flow oxygen while Pen hou fang in the control group.Sputum was collected at different time to detect the interleukin 8(IL-8)and tumor necrosis factor alpha(TNF-α)level.Complete blood count and the percentage of neutrophils were calculated at the same time interval.Special score method was used to evaluate the patients'cough and expectoration symptom.The temperature curve was drawn and the postoperative pulmonary complications were compared.

Results

The postoperative temperature and CBC and neutrophil percentages had no differences between the two groups.The IL-8 and TNF-αlevel in the sputum significantly increased after operation(P<0.05).They decreased to the preoperation level on the 4th in the experimental group while not for the control group.When compared between groups,the IL-8 and TNF-αlevel of the experimental group were significantly lower than that of the control group(P<0.05).The volume of expectorated sputum,the score of the cough and expectoration symptom of the experimental group were lower than those of the control group.

Conclusions

Inhalation with budesonide significantly improved the posterative cough and expectoration symptoms and relieved the postoperative airway inflammation,which was advised to be put into clinical practice.

Key words: Inhalation, airway inflammation, upper abdominal surgery, bronchial anaesthesia
表1 病人一般临床资料比较
组别 性别 年龄(岁) 吸烟人数(例) 手术时间(分钟) 停留胃管时间(天) 住院天数(天) 术后吸氧时间(天)
男 女
实验组 21 9 59.5±15.13 15 269.71±89.45 3.59±2.09 20.36+6.90 2.27±1.22
对照组 23 7 49.82±12.7 13 204.70±74.56 3.00±1.32 20.91+8.19 2.44±1.13
χ2 0.341 0.359
t 1.74 1.933 0.762 -0.183 -0.354
P 0.771 0.094 0.72 0.065 0.45 0.856 0.726
表2 两组的咳嗽、咳痰评分
分组 pod1 pod2 pod3 pod4 pod5 pod6
实验组(分) 1.9 2.3 1.8 0.8 0.4 0.5
对照组(分) 1.8 2.7 2.3 1.2 0.3 0.4
表3 实验组和对照组IL-8和TNF-α比较
指标(ng/ml) 时间 实验组 对照组
IL-8 pre 4.02±3.76 3.76±3.47
pod 1 7.02±3.51* 6.75±3.27*
pod 4 3.51±2.88△ 5.95±2.94
TNF-α pre 2.32±1.07 1.76±0.58
pod 1 5.46±6.30* 6.38±5.83*
pod 4 2.07±1.49△ 4.74±4.83△#▲
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