摘要
目的 探讨加用糖皮质激素雾化吸入对肝切除术后患者肺部感染的预防效果及作用机制.方法 回顾性分析2013 年1 月至2014 年12 月在中山大学附属第三医院行肝切除术的66 例肝硬化合并原发性肝癌（肝癌）患者临床资料.所有患者均签署知情同意书,符合医学伦理学规定.根据治疗方法的不同将患者分为治疗组和对照组.其中治疗组36 例,男28 例,女8 例;年龄21～66 岁,中位年龄43 岁;均采用“布地奈德（普米克令舒）1 mg ＋ 氨溴索（沐舒坦）30 mg”雾化吸入,2 次/d,持续6 d.对照组30 例,男18 例,女12 例;年龄23～67 岁,中位年龄48 岁;均采用“氨溴索（沐舒坦）30 mg”雾化吸入,2 次/d,持续6 d.观察两组患者的动脉血气分析结果及X- 线胸片的变化.两组患者动脉血气分析结果比较采用t 检验,率的比较采用χ2 检验.结果 雾化吸入治疗后,治疗组的血氧分压（PaO2） 及氧合指数（OI） 分别为（116±15）、（590±42）mmHg（1 mmHg=0.133 kPa）,较治疗前的（85±17）、（452±54）mmHg 明显升高（t=2.426,2.533;P〈0.05）;对照组的PaO2 及OI 分别为（101±16）、（535±50）mmHg,亦较治疗前的（86±16）、（460±56）mmHg 明显升高（t=3.401,2.440;P〈0.05）.治疗组的肺泡- 动脉血氧梯度（A-aDO2）为（65±18）mmHg, 较治疗前的（96±22）mmHg 明显降低（t=-3.578,P〈0.05）.治疗组与对照组治疗后PaO2、A-aDO2 比较差异有统计学意义（t=3.925,-6.355;P〈0.05）.治疗组术后肺部感染发生率为6%（2/36）,明显低于对照组的13%（4/30）（ χ2=15.240,P〈0.05）.结论 肝切除患者术后加用糖皮质激素雾化吸入可能通过提高PaO2、改善组织器官的氧合状况和肺换气功能,有效预防肺部感染的发生.
Objective To investigate the prevention effect and mechanism of glucocorticoid aerosol inhalation on pulmonary infection after hepatectomy. Methods Clinical data of 66 liver cirrhosis patients complicated with primary liver cancer (liver cancer) undergoing hepatectomy in the Third Afifliated Hospital of Sun Yat-sen University between January 2013 and December 2014 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients were divided into the treatment group and control group according to the treatment methods. In the treatment group, 36 patients were included, 28 males and 8 females, aged from 21 to 66 years with a median age of 43 years. All patients were given with aerosol inhalation of 1 mg of budesonide (pulmicort)+30 mg of ambroxol (mucosolvan), twice daily for consecutive 6 d. In the control group, 30 patients were included, 18 males and 12 females, aged ranging from 23 to 67 years with a median age of 48 years. All cases were given with aerosol inhalation of 30 mg of ambroxol (mucosolvan), twice daily for consecutive 6 d. The changes of the arterial blood gas analysis results and X-ray radiography were observed between two groups. Arterial blood gas analysis results of two groups were compared using t test and the ratio was compared using Chi-square test. Results After aerosol inhalation, partial pressure of oxygen (PaO2) and oxygenation index (OI) in the treatment group were (116±15) and (590±42) mmHg (1 mmHg=0.133 kPa), signiifcantly higher compared with (85±17) and (452±54) mmHg before treatment( t=2. 4 2 6 , 2. 5 3 3;P<0.05). In the control group, PaO2 and OI were (101±16) and (535±50) mmHg after aerosol inhalation, signiifcantly higher compared with (86±16) and (460±56) mmHg before treatment (t=3.401, 2.440;P<0.05). In the treatment group, alveolar-arterial oxygen difference (A-aDO2) was (65±18) mmHg, significantly lower than (96±22) mmHg before treatment (t=-3.578, P<0.05). After aerosol inhal
出处
《中华肝脏外科手术学电子杂志》
CAS
2016年第2期101-104,共4页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
广东省科技计划项目(2010B060900024)
