摘要
目的 探讨吸入性糖皮质激素是否可减轻肺少血复杂先天性心脏病患者体外循环术后急性肺损伤,改善肺功能不全.方法 入组2015-2016年武汉亚洲心脏病医院就诊的肺少血复杂先心病患者36例,所有患者在体外循环下行矫治术后随机分为2组：试验组给予布地奈德1 mg＋基础雾化剂,对照组给予生理盐水2 ml＋基础雾化剂,吸入方式、时间及剂量均相同,其他呼吸道管理措施及临床治疗原则无差异.对比分析主要观察指标,包括有创呼吸机时间、无创呼吸机时间、ICU停留时间、住院时间、肺炎发生率及总死亡率;次要观察指标包括术后不同时段的白细胞、降钙素原、氧合指数、动脉二氧化碳分压和呼气末正压.结果 试验组无创呼吸机时间[（41.00±21.20）h比（58.44±20.69）h]、ICU停留时间[（5.50±2.33）d比（7.33±2.03）d]及住院时间[（11.28±3.80）d比（14.00±2.54）d]比对照组短,其他主要指标无差异;在观察阶段中后期各次要指标试验组优于对照组[如术后第7天降钙素原（1.99±1.39）ng/ml比（3.58±2.21）ng/ml],早期则无差异.结论 应用吸入性糖皮质激素可在一定程度上一定时间段内减轻肺少血复杂先天性心脏病患者术后急性肺损伤,促进肺功能恢复并缩短病程.
Objective To investigate whether inhaled corticosteroids can reduce acute lung injury and improve pulmonary function after cardiopulmonary bypass. Methods Selected all the 36 patients in Wuhan Asia Heart Hospital during 2015-2016 with complex cyanotic congenital heart disease with reduced pulmonary blood flow. All the patients were randomly divided into two groups after underwent radical surgery through cardiopul-monary bypass. The test group was given budesonide 1 mg with basic atomizing drugs,while the control group was given saline 2 ml with basic atomizing drugs. Inhalation equipment,time and dose between them were the same. All the other respiratory management measures and clinical treatment principles were in no difference. Analysis of the main observation indexes comparatively,including invasive ventilator assisting time,non-invasive ventilator as-sisting time,ICU time,hospital stay,pneumonia incidence and mortality. The secondary observation indexes were white blood cell count,procalcitonin,oxygenation index,arterial partial pressure of carbon dioxide and positive end-expiratory pressure in different time post operation. Results The non-invasive ventilator assisting time [（41.00±21.20）h vs（58.44±20.69）h],ICU time[（5.50±2.33）d vs（7.33±2.03）d]and hospital stay[（11.28± 3.80）d vs（14.00±2.54）d]in the experimental group were shorter than that in the control group,with other major indicators no difference. Secondary indexes were superior to the control group in the late obsevating period[eg. Pro-calcitonin in the 7 day after surgery was（1.99±1.39）ng/ml vs（3.58±2.21）ng/ml],but no difference was found in the early stage. Conclusion Application of inhaled glucocorticoids could reduce the postoperative acute lung injury, promote the recovery of pulmonary function and shorten the course of disease in a certain period and certain extent.
出处
《中国心血管病研究》
CAS
2017年第3期268-273,共6页
Chinese Journal of Cardiovascular Research
基金
号：武汉市卫计委课题基金资助项目（课题编号：WX15D12）
武汉市中青年医学骨干人才专项基金（武卫生计生201477号）
关键词
体外循环
急性肺损伤
肺功能不全
吸入性糖皮质激素
Cardiopulmonary bypass
Acute lung injury
Pulmonary insufficiency
Inhaled corticos-teroids
