大剂量盐酸氨溴索在婴幼儿先天性心脏病外科治疗中的肺保护作用

目的观察大剂量盐酸氨溴索在婴幼儿先天性心脏病(CHD)治疗中的肺保护作用。方法选取婴幼儿CHD心脏直视手术170例,根据体外循环(CPB)术后是否使用盐酸氨溴索将其分为2组:对照组85例和氨溴索组85例。2组病例术前一般资料、心功能的差异均无统计学意义。氨溴索组术中术后使用盐酸氨溴索20 mg.kg-1.d-1,共5 d;对照组术中术后未使用盐酸氨溴索治疗。观察2组患儿术后肺功能指标,分别于CPB前、CPB结束、手术结束、术后6 h及术后24 h测定2组患儿氧合指数和肺静态顺应性;比较2组患儿肺部感染及肺不张发生率的差异;比较2组术后呼吸机辅助时间及ICU监护时间的差异。结果氨溴索组肺部感染率及肺不张发生率明显低于对照组(Pa<0.05);氨溴索组术后呼吸机辅助时间及ICU监护时间显著少于对照组(Pa<0.05)。2组术前氧合指数及肺静态顺应性比较差异均无统计学意义(Pa>0.05);2组CPB结束、手术结束、术后6 h、术后24 h的氧合指数及肺静态顺应性均较术前明显下降(Pa<0.01);氨溴索组CPB结束、手术结束、术后6 h及术后24 h氧合指数均高于对照组(Pa<0.05);氨溴索组肺静态顺应性变化程度明显低于对照组(P<0.05)。结论盐酸氨溴索可有效改善CHD婴幼儿CPB术后肺功能,防治肺部并发症,缩短辅助通气及监护时间。

Protective Effect of High - Dose Ambroxol Hydrochloride on Lung during Surgical Treatment in Infants with Congenital Heart Disease

Objective To investigate the value of high-dose ambroxol hydrochloride in the treatment of lung protection of infants with congenital heart disease(CHD). Methods One hundred and seventy CHD infants after surgical treatment were divided into 2 groups(85 cases in ambroxol group,85 cases in control group).The patients in ambroxol group were used ambroxol hydrochloride for 5 days from operation beginning,with the dose of 20 mg·kg-1·d-1.The patients in control group did not use ambroxol hydrochloride.The lung function were investigated in the 2 groups.Before cardiopulmonary bypass(CPB),CPB over,operation over and 6 h after operation,24 h after operation,oxygen index and lung static compliance were analyzed in the 2 groups.The differences of lung infection and atelectasis rate in the 2 groups were observed.And the difference of time in ventilator auxiliary with intensive care unit(ICU) was observed. Results The rates of lung infection and atelectasis in ambroxol group were lower than those in control group(Pa<0.05).Ventilator auxiliary time in ambroxol group was shorter than that in control group as the same as ICU time(Pa<0.05).Oxygen index and lung static compliance had no difference between the 2 groups before operation(Pa>0.05);Oxygen index and lung static compliance declined obviously after operation(CPB over,operation over and 6 h after operation,24 h after operation) in the 2 groups(Pa<0.01),and oxygen index in ambroxol group was higher than that in control group(Pa<0.05).The variations of lung static compliance in ambroxol group was lower than that in control group obviously after operation(Pa<0.05). Conclusions Ambroxol hydrochloride can improve pulmonary function and prevent pulmonary complication in infants after operation,and can reduce the time in ventilator auxiliary with ICU.