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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2024, Vol. 13 ›› Issue (04) : 531 -536. doi: 10.3877/cma.j.issn.2095-3232.2024.04.016

临床研究

布地奈德联合复方异丙托溴铵雾化吸入在老年患者腹腔镜围手术期中的应用
陈先志1, 许磊1,†(), 冯其柱1, 王琦1   
  1. 1. 232007　安徽省淮南市，安徽理工大学第一附属医院普通外科
  • 收稿日期:2024-03-20 出版日期:2024-08-10
  • 通信作者: 许磊
  • 基金资助:
    安徽省省级临床重点专科建设项目(2022-21); 淮南市指导性科技计划项目(2021-66); 淮南市"50·科技之星"创新团队(2022-07)

Application of budesonide combined with inhaled compound ipratropium bromide in elderly patients during perioperative period of laparoscopic surgery

Xianzhi Chen1, Lei Xu1,†(), Qizhu Feng1, Qi Wang1   

  1. 1. Department of General Surgery, the First Affiliated Hospital of Anhui University of Science and Technology, Huainan 232007, China
  • Received:2024-03-20 Published:2024-08-10
  • Corresponding author: Lei Xu
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陈先志, 许磊, 冯其柱, 王琦. 布地奈德联合复方异丙托溴铵雾化吸入在老年患者腹腔镜围手术期中的应用[J]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 531-536.

Xianzhi Chen, Lei Xu, Qizhu Feng, Qi Wang. Application of budesonide combined with inhaled compound ipratropium bromide in elderly patients during perioperative period of laparoscopic surgery[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(04): 531-536.

目的

探讨布地奈德联合复方异丙托溴铵雾化吸入在老年患者腹腔镜4类手术围手术期气道管理中的应用价值。

方法

本研究对象为2021年1月至2022年9月在安徽理工大学第一附属医院接受腹腔镜手术的83例老年患者。患者均签署知情同意书，符合医学伦理学规定。其中男58例，女25例；年龄60～88岁，中位年龄70岁。按照随机数字表法分成观察组（35例）和对照组（48例）。观察组于术前3 d直至术后7 d给予复方异丙托溴铵及布地奈德混悬雾化吸入；对照组给予生理盐水雾化吸入。两组术前及术后用力肺活量（FVC）、一秒率（FEV1.0%）变化采用重复测量数据的方差分析；两组手术后肺部并发症（PPCs）比较采用χ2检验，住院天数及总费用等指标比较采用Mann-Whitney U检验。

结果

重复测量数据方差分析显示，观察组与对照组FVC、FEV1.0%组间差异有统计学意义（F=4.826，7.340；P<0.05）。观察组FVC及FEV1.0%总体变化趋势明显优于对照组（F=256.728，65.699；P<0.05）。观察组与对照组术后呼吸道症状发生率分别为34%（12/35）、56%（27/48），PPCs发生率分别为26%（9/35）、48%（23/48），差异有统计学意义（χ2=3.920，4.212；P<0.05）。观察组与对照组总住院天数分别为19（15，27）、22（19，28）d，住院总费用分别为5.3（4.4，6.5）、6.2（5.3，7.8）万元，差异有统计学意义（Z=-2.263，-2.896；P<0.05）。

结论

老年患者腹腔镜术后PPCs发生率较高，围手术期予以复方异丙托溴铵联合布地奈德混悬雾化吸入可有效提高患者肺功能储备，从而减少PPCs发生，缩短总住院时间，降低经济负担。

关键词: 腹腔镜, 老年患者, 布地奈德, 复方异丙托溴铵, 雾化吸入, 肺功能, 手术后并发症
Objective

To evaluate the application value of budesonide combined with inhaled compound ipratropium bromide in perioperative airway management in elderly patients undergoing 4 types of laparoscopic surgery.

Methods

83 elderly patients undergoing laparoscopic surgery in the First Affiliated Hospital of Anhui University of Science and Technology from January 2021 to September 2022 were enrolled. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 58 patients were male and 25 female, aged from 60 to 88 years, with a median age of 70 years. All patients were divided into the observation group (n=35) and control group (n=48) according to the random number table method. In the observation group, compound ipratropium bromide combined with budesonide suspension inhalation was given from 3 d before surgery to 7 d after surgery. In the control group, saline inhalation was given. The changes of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1.0%) before and after surgery in two groups were analyzed by repeated measures analysis of variance. The incidence of postoperative pulmonary complications (PPCs) between two groups was compared by Chi-square test. The length of hospital stay and total expense were compared by Mann-Whitney U test.

Results

Repeated measures analysis of variance showed that the differences in the FVC and FEV1.0% were statistically significant between the observation and control groups (F=4.826, 7.340; P<0.05). The overall change trends of FVC and FEV1.0% in the observation group were significantly better than those in the control group (F=256.728, 65.699; P<0.05). The incidence rates of postoperative respiratory symptoms in the observation and control groups were 34%(12/35) and 56%(27/48), and 26%(9/35) and 48%(23/48) for PPCs, with statistical significance (χ2=3.920, 4.212; P<0.05). In the observation and control groups, the total length of hospital stay were 19(15, 27) d and 22(19, 28) d, and 53 000(44 000, 65 000) Yuan and62 000(53 000, 78 000) Yuan for the total hospitalization expenses, with statistical significance (Z=-2.263,-2.896; P<0.05).

Conclusions

The incidence of PPCs is high in elderly patients after laparoscopic surgery. Perioperative use of compound ipratropium bromide combined with budesonide suspension inhalation can effectively improve lung function reserve, thereby decreasing the incidence of PPCs, shortening the total length of hospital stay and mitigating the economic burden.

Key words: Laparoscopes, Elderly patients, Budesonide, Compound ipratropium bromide, Atomization inhalation, Lung function, Postoperative complications
表1 观察组和对照组老年腹腔镜手术患者一般资料比较
组别 例数 年龄[岁，M（Q1，Q3）] 性别（例） BMI（kg/m2，±s） 原发病（例）
男 女 直肠肿瘤 胃肿瘤 结肠肿瘤 肝脏肿瘤
观察组 35 72（66，74） 27 8 22.0±1.7 11 8 7 9
对照组 48 68（64，75） 31 17 21.9±1.5 19 8 12 9
统计值   Z=1.639 χ2=1.517 t=0.116 χ2=0.583 χ2=0.498 χ2=0.287 χ2=0.578
P值   0.101 0.218 0.908 0.445 0.480 0.592 0.447
表2 观察组和对照组老年腹腔镜手术患者围手术期血液检测指标比较
组别 例数 术前 术后7 d
ALB（g/L，±s） BUN [mmol/L，M（Q1，Q3）] Hb（g/L，±s） ALB（g/L，±s） BUN [mmol/L，M（Q1，Q3）] Hb（g/L，±s）
观察组 35 40±4 6.1（5.1，6.8） 120±15 39±4 6.6（4.5，8.5） 101±14a
对照组 48 40±3 5.6（4.3，6.7） 113±20 36±4a 7.9（6.0，9.5）a 97±20a
统计值   t=0.253 Z=1.181 t=1.541 t=3.092 Z=-1.983 t=0.494
P值   0.803 0.238 0.127 0.003 0.047 0.622
表3 观察组和对照组老年腹腔镜手术患者FVC和FEV1.0%比较（±s）
组别 例数 FVC 统计值 P值
入院时 手术当天 术后7 d
观察组 35 2.9±0.7 2.9±0.7 2.8±0.7 F=472.651 <0.001
对照组 48 2.8±0.6 2.8±0.6 2.0±0.6    
统计值   t=0.620 t=0.890 t=-5.085 F=4.826 F=256.728
P值   0.537 0.376 <0.001 0.031 <0.001
组别 例数 FEV1.0% 统计值 P值
入院时 手术当天 术后7 d
观察组 35 0.76±0.09 0.88±0.07 0.73±0.08 F=350.641 <0.001
对照组 48 0.77±0.10 0.78±0.09 0.66±0.09    
统计值   t=-0.728 t=5.175 t=3.602 F=7.340 F=65.699
P值   0.469 <0.001 <0.001 0.008 <0.001
表4 观察组与对照组老年腹腔镜手术患者术后指标比较
组别 例数 手术时间（min，±s） 术中出血（ml，±s） 呼吸道症状（例） PPCs（例） 总住院天数[d，M（Q1，Q3）] 住院总费用[万元，M（Q1，Q3）]
观察组 35 108±23 53±16 12 9 19（15，27） 5.3（4.4，6.5）
对照组 48 108±21 52±15 27 23 22（19，28） 6.2（5.3，7.8）
统计值   t=0.063 t=0.296 χ2=3.920 χ2=4.212 Z=-2.263 Z=-2.896
P值   0.950 0.768 0.048 0.040 0.024 0.004
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