盐酸氨溴索注射剂不同给药途径在心脏手术围术期的临床应用

目的了解某院心脏手术患者围手术期盐酸氨溴索注射剂不同给药途径的用药情况,为临床合理使用该药提供参考。方法纳入行心脏手术的心外科患者,使用盐酸氨溴索注射剂的作为试验组,并按给药途径分为静脉组、雾化组和静脉联合雾化组(简称"联合组");未使用盐酸氨溴索注射剂的作为对照组。对比不同给药途径组患者术后肺部并发症(postoperative pulmonary complications,PPCs)的发生率、重插管发生率、总呼吸机使用时间、纤支镜吸痰率、好转率、ICU停留时间和总住院时间。结果共纳入916例患者,其中静脉组180例、雾化组104例、联合组524例、对照组108例。PPCs在心脏手术术后的总发生率为94.2%,不同给药途径组的PPCs发生率(P=0.977)无统计学差异;呼吸机使用时间仅对照组与联合组存在统计学差异(P<0.001),其他组之间无统计学差异(P>0.008);重插管率除雾化组无重插管病例,与其他各组的差异有统计学意义外,静脉组(6.0%)、联合组(6.1%)和对照组(11.1%)之间无统计学差异(P>0.008)。不同给药途径组的愈后好转率(P=0.320)无统计学差异;对于ICU停留时间,静脉组、雾化组和联合组的时间较对照组长,差异有统计学意义(P<0.001),其他各组间的差异无统计学意义(P>0.008);对于纤支镜吸痰率,雾化组(0.0%)<对照组(0.9%)<静脉组(4.4%)<联合组(7.6%);对于总住院时间(P<0.001),中位住院天数对照组(15 d)<静脉组(19 d)<雾化组(21 d)≈联合组(21 d)。结论不同给药途径的盐酸氨溴索注射剂对患者的术后临床结局影响无明显差异,需设计前瞻性试验进一步验证。

Clinical Application of Ambroxol Hydrochloride Injection by Different Administration Routes in the Perioperative Period among Patients Undergoing Cardiac Surgery

OBJECTIVE To investigate the situation of ambroxol hydrochloride injection by different administration routes in the perioperative period among patients undergoing cardiac surgery in Guangdong General Hospital,so as to provide references for the rational use of ambroxol injection. METHODS Patients who underwent cardiac surgery and used ambroxol hydrochloride injection were in the experimental group,and the experimental group was further divided into three groups,intravenous,atomization,and intravenous combined atomization (the "combined group ") according to the routes of administration. Patients not injected with ambroxol hydrochloride were considered as a blank control group. Incidence of postoperative pulmonary complications (PPCs) after cardiac surgery,incidence of reintubation,time of mechanical ventilation,incidence of fiberbronchoscope suction,improvement rate,time stay in ICU,and time stay in hospital among the groups were compared. RESULTS A total of 916 patients were a included,of which the injection group contained 108 cases,inhalation group 104 cases,combination group 524 cases,and control group 108 cases. The incidence of PPCs was 94. 2%. No significant differences (P = 0. 977) were found in the incidences of PPCs among groups. Time of mechanical ventilation was statistically different between combination group and control group only (P < 0. 001) and there was no significant difference among experimental groups (P > 0. 008). Except inhalation group had no case for reintubation,incidences of reintubation were not significantly different (P > 0. 008) between injection group (6. 0%),combination group (6. 1%) and control group (11. 1%). Improvement rate was not significantly different among experimental groups (P = 0. 320);. Time stay in ICU,injection group,inhalation group,and combination group were longer than that in control group and significantly different (P<0. 001)compared with that in control group. However,there was no significant difference between other groups (P>0. 008). The combination group has the greatest incidence of fiberbronchoscope suction (7. 6%),followed by that in injection group (4. 4%),control group (0.9%),and inhalation group (0. 0%). Control group has the shortest time stay in hospital (15 d),followed by injection group (19 d),inhalation group (21 d),combination group (21 d). CONCLUSION The prognosis of patients for cardiac surgery has no significant difference among the groups with ambroxol hydrochloride injection by different administration routes in the perioperative period. Further well-designed prospective studies should be conducted for validation.