發(fā)布時(shí)間：2018-07-27 09:23

【摘要】：目的單肺通氣時(shí)最常見的問(wèn)題是低氧血癥。造成低氧血癥的原因很多,但主要原因是肺內(nèi)分流。手術(shù)過(guò)程中的各種刺激,均可引發(fā)肺炎性反應(yīng),促使大量炎性因子釋放。細(xì)胞因子瀑布級(jí)聯(lián)反應(yīng)和白細(xì)胞過(guò)度的激活,引起肺部炎癥反應(yīng),造成肺損傷,促使肺不張的發(fā)生。外界刺激引發(fā)肺部炎性反應(yīng),炎癥反應(yīng)引起炎性因子過(guò)度釋放,過(guò)度釋放的炎性因子可加重肺內(nèi)分流。所以保護(hù)肺功能,抑制炎性反應(yīng)可有效減少肺內(nèi)分。鹽酸氨溴索是新一代黏痰的稀釋劑,已經(jīng)有研究表明,除化痰作用外,氨溴索還有其它的一系列肺保護(hù)作用。如促進(jìn)肺泡表面物質(zhì)分泌,減小肺表面張力.防止肺泡萎陷;具有抗氧化作用,減輕氧化性肺損傷;具有抗炎作用,可減少炎癥細(xì)胞及炎性介質(zhì)的釋放,減輕炎癥反應(yīng)引起的肺損傷。本研究將僅限于觀察并證實(shí)術(shù)前靜脈注射氨溴索是否有助于減少肺內(nèi)分流并改善動(dòng)脈血氧合,并探討氨溴索是否對(duì)食管癌根治術(shù)患者具有肺保護(hù)作用。研究方法選擇行左進(jìn)胸食管癌根治術(shù)患者100例,男65例,女35例,年齡在30~64歲之間,ASAⅠ或Ⅱ級(jí),體重48~80 kg,身高158~182 cm,術(shù)前肺功檢查結(jié)果均正�；騼H有輕微通氣障礙,無(wú)心臟病史,心功能Ⅰ~Ⅱ級(jí),排除肝腎功能異�；颊摺２捎脭�(shù)字表法,將患者隨機(jī)分為兩組(n=50):鹽酸氨溴索(M組),生理鹽水組(NS組)。M組于麻醉前30 min靜滴鹽酸氨溴索5 mg/kg,NS組給予等容量生理鹽水。在雙肺通氣10 min(To)、單肺通氣35 min(T1)、恢復(fù)雙肺通氣30 min(T2)時(shí)采集橈動(dòng)脈和頸內(nèi)靜脈血樣,行血?dú)夥治霾⑼瑫r(shí)測(cè)定MAP、Sp O2、平均氣道壓(Pmean),計(jì)算肺內(nèi)分流率(QS/QT)。結(jié)果兩組患者的Pmean以及血流動(dòng)力學(xué)指標(biāo)相比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.5)。與To相比較兩組T1、T2時(shí),QS/QT升高,Pa O2降低(P0.5)。與T1比較兩組T2時(shí),QS/QT降低,Pa O2升高(P0.5)。與NS組相比較,M組T1、2時(shí)QS/QT降低,Pa02升高(P0.05)。結(jié)論術(shù)前靜脈滴注大劑量鹽酸氨溴索可減少食管癌根治術(shù)患者單肺通氣時(shí)肺內(nèi)分流,改善患者氧合功能,具有肺保護(hù)作用。
[Abstract]:Objective the most common problem in single lung ventilation is hypoxemia. There are many reasons for hypoxemia, but the main cause is intrapulmonary shunt. All kinds of stimuli during the operation can induce pneumonic response and promote the release of a large number of inflammatory factors. Cytokine cascade reaction and excessive activation of white blood cells cause pulmonary inflammation, lung injury and atelectasis. External stimuli induce pulmonary inflammatory response, inflammatory response causes excessive release of inflammatory factors, excessive release of inflammatory factors can aggravate intrapulmonary shunt. Therefore, the protection of lung function, inhibition of inflammatory response can effectively reduce intrapulmonary score. Ambroxol hydrochloride is a new generation of diluent for mucus phlegm. It has been shown that ambroxol has a series of pulmonary protective effects in addition to the role of phlegm. If promote alveolar surface matter secretion, reduce lung surface tension. It can prevent alveolar collapse; have antioxidant effect and reduce oxidative lung injury; have anti-inflammatory effect, can reduce the release of inflammatory cells and inflammatory mediators, and alleviate lung injury caused by inflammatory reaction. This study will be limited to observing and verifying whether intravenous ambroxol before operation can reduce intrapulmonary shunt and improve arterial oxygenation, and to explore whether ambroxol has lung protective effect on patients undergoing radical resection of esophageal cancer. Methods 100 patients (65 males and 35 females) undergoing radical resection of left thoracic esophageal carcinoma were selected. The age of ASA 鈪，

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