沙丁胺醇预先给药对慢性阻塞性肺疾病患者腹腔镜手术呼吸力学的影响

目的 探讨沙丁胺醇预先给药对慢性阻塞性肺疾病患者腹腔镜手术呼吸力学的影响.方法 选择2012年3月～2013年5月在我院进行腹腔镜手术合并COPD患者50例,随机分为观察组和对照组各25例.观察组在麻醉诱导前先吸入硫酸沙丁胺醇气雾剂,对照组未给药,比较两组术前及术中血气分析和呼吸力学参数.结果 观察组pH值和PaCO2值在T0～T4期间无显著波动（P＞0.05）,PaO2/FiO2在T1～T3下降,T4回升,T0～T4期间波动有统计学意义（P＜0.05）;对照组pH值、PaCO2值和PaO2/FiO2在T0～T4期间均存在显著波动（P＜0.05）,观察组T2、T3时pH值明显高于对照组,T2～T4 PaCO2值均显著低于对照组,T1～T4 PaO2/FiO2均显著高于对照组（P＜0.05）.观察组T1～T4 Ppeak、Pplat、Raw有明显波动,均呈升高后降低（P＜0.05）,Compl的波动并不显著（P＞0.05）;对照组T1～T4 Ppeak、Pplat、Raw、Compl均有明显波动,Ppeak、Pplat、Raw呈显著升高后降低,Compl显著降低T4回升（P＜0.05）.结论 沙丁胺醇预先给药能够有效缓解慢性阻塞性肺疾病患者术中气道应激反应,抑制气道压力和阻力升高,增加肺顺应性,改善肺通气功能,有助于提高麻醉安全性.

Impact of salbutamol pretreatment on chronic obstructive pulmonary dis-ease respiratory mechanics of laparoscopic surgery

Objective To study salbutamol pretreatment on chronic obstructive pulmonary disease respiratory mechan- ics of laparoscopic surgery. Methods March 2012 - May 2013 laparoscopic surgery in our hospital 50 patients with COPD were randomly divided into observation group and control group, 25 cases in the observation group before in- duction of anesthesia albuterol sulfate inhalation aerosol, control group, no treatment were compared preoperative and intraoperative blood gas analysis and respiratory mechanics parameters. Results The pH value and PaCO2 values TO ~ T4 no significant fluctuations during the period （P 〉 0.05）, PaOE/FiO2 decreased in T1-T3, T4 rise, T0-T4 statistically significant fluctuations during the period （P 〈 0.05）, pH value of the control group, PaCO2 values and the PaO2/FiO2 at T0-T4 period there were significant fluctuations （/9 〈 0.05）, the observation group I＇2, T3 were significantly higher when the pH value, T2~T4 PaCO2 values were significantly lower than the control group, T1 ~T4 PaO~fFiO2 were sig- nificantly higher （P 〈0.05）. Observation group TI~T4 Ppeak, Pplat, Raw significant fluctuations, showed increased and then decreased （P 〈0.05）, Compl fluctuations were not significant （P 〉 0.05）, the control group TI~T4 Ppeak, Pplat, Raw, Compl were there were significant fluctuations, Ppeak, Pplat, Raw were significantly increased and then de- creased, Compl rebounded significantly lower T4 （P 〈 0.05）. Conclusion Salbutamol pretreatment can effectively alle- viate the chronic obstructive pulmonary disease in patients undergoing airway stress response, inhibiting airway pres- sure and resistance increases, increased pulmonary compliance increased oxygen utilization, improve lung function, help to improve the anesthesia security.