术后诱发性肺量计训练和雾化吸入治疗对全身麻醉腹部手术患者的临床价值

目的探讨呼吸锻炼和雾化吸入治疗对外科ICU全身麻醉（全麻）腹部手术后患者的肺功能、气道分泌物清除效果的影响。方法 200例腹部手术后患者根据性别、年龄、手术部位等随机分为四组：术后患者一般治疗组（A组）,在一般治疗基础上诱发性肺量计（IS）训练组（B组）,布地奈德＋特布他林＋盐酸氨溴索雾化吸入治疗组（C组）,布地奈德＋特布他林＋盐酸氨溴索雾化吸入和IS训练联合治疗组（D组）。监测患者拔管后0.5、24及48 h肺功能指标（FVC、FEV1和PEF）,血气分析指标（SaO2、PaO2和PaCO2）,气道分泌物清除效果及临床疗效,随访患者转出ICU后的气管插管率。结果肺功能指标和血气分析指标,气道分泌物清除效果、呼吸系统症状改善效果及气管插管情况,B组、C组和D组均优于A组,以D组最佳,差异有统计学意义（P〈0.05）,尤其是对高龄、吸烟、原有肺部疾病的高危险因素患者更明显。其中C组和D组患者的气道分泌物清除效果较B组和A组明显,差异有统计学意义（P〈0.05）。结论对于全麻腹部外科术后患者早期应用IS训练和布地奈德＋特布他林＋盐酸氨溴索雾化吸入联合治疗,能促进患者的气道分泌物清除和肺功能的恢复,尤其是对高龄、吸烟、原有肺部疾病的高危险因素患者具有十分重要的意义。

Clinical Significance of Combined Use of Incentive Spirometry and Aerosol Inhalation in Patients after Abdominal Surgery in General Anesthesia

Objective To evaluate the therapeutic effects of different airway management strategies early used for patients after abdominal surgery in general anesthesia.Methods According to gender,age,and operation location,200 patients after abdominal surgery in general anesthesia were randomly assigned to four groups,ie.a conventional treatment group（Group A）,an incentive spirometry（IS） therapy group（Group B）,an aerosol inhalation group（Group C）,a combination of inhalation and IS therapy group（Group D）.Inhalation drugs included Budesonide,Terbutaline,and Ambroxol.The index of pulmonary function test（FVC,FEV1,PEF） and arterial blood gases analysis（ABG） were measured,and the effect of secretions clearance and the improvement of respiratory symptoms were evaluated at 0.5 h,24 h,48 h after extubation.Intratracheal intubation of the patients after leaving ICU was followed up.Results FVC,FEV1,PEF,ABG,sputum volume,the effect of secretions clearance,clinical efficacy,and intratracheal intubation rate in group B,C and D were improved more significantly than those in group A.And the therapeutic effect was best in group D（P0.05）.The secretions clearance was improved more better in group C and D,especially in those high-risk patients with advanced age,smoking history,and pulmonary cormobidities（P0.05）.Conclusions The combined use of IS training and inhalation therapy can improve airway secretions clearance and pulmonary function particularly for those patients after abdominal surgery in general anesthesia,especially for those high-risk patients.