摘要
目的探讨围手术期应用小剂量氨茶碱对连枷胸合并呼吸衰竭患者脑氧代谢和呼吸力学的效果及安全性.方法采用前瞻性研究方法,将46例连枷胸合并呼吸衰竭患者随机分为两组(每组各23例).两组均采用肋骨环抱器内固定术进行治疗,对照组仅进行手术,研究组在围手术期静脉注射0.125 g氨茶碱.记录基本手术情况及并发症,并分别于氨茶碱应用前及应用10 min、30 min、60 min观察患者呼吸力学指标气道峰值压力、气道平台压、气道阻力和胸肺顺应性,脑氧代谢指标静脉血氧饱和度(SjvO2)、动静脉氧含量差(a-vDO2)、脑氧代谢率(CMRO2).结果两组患者手术时间、术中出血量、引流管留置时间、住院时间差异无统计学意义(P>0.05);术中与术后并发症发生率差异也无统计学意义(P>0.05).治疗前,两组呼吸力学和脑氧代谢指标差异均无统计学意义(P>0.05);治疗后,研究组气道峰值压力、气道平台压力、气道阻力均降低,肺顺应性和CMRO2升高,任一时间点与治疗前及对照组比较差异均有统计学意义(P<0.05).结论围手术期应用小剂量氨茶碱有利于改善连枷胸合并呼吸衰竭患者脑氧代谢和呼吸力学,具有一定的临床价值.
Objective To investigate the effect and safety of using low-dose aminophylline to improve cerebral oxygen metabolism and respiratory mechanics in patients with flail chest combined with respiratory failure during operation.Methods In this prospective study,46 patients with flail chest combined with respiratory failure was conducted and divided into two groups randomly.Both groups were treated by internal fixation with rib cage.The control group received conventional surgery,and the study group received intravenous injection of 0.125 g/kg aminophylline during the perioperative period.Basic surgical conditions and complications were recorded.The respiratory mechanical indexes such as peak airway pressure,airway platform pressure,airway resistance,and lung compliance,the cerebral oxygen metabolism indexes such as venous oxygen saturation(SjvO2),arteriovenous oxygen content difference(a-vDO2),and cerebral oxygen metabolism rate(CMRO2)before the use of aminophylline and at 10 min,30 min and 60 min after the use of aminophylline were compared respectively.Results There was no significant differences between the two groups in operation time,intraoperative blood loss,drainage tube indwelling time and hospitalization time(P>0.05).There was no significant difference in the incidence of intraoperative and postoperative complications too(P>0.05).Before the application of aminophylline,there was no significant difference in respiratory mechanics and cerebral oxygen metabolism between the two groups(P>0.05).After theophylline was applied,there was no significant change in each index in the control group(P>0.05),while the peak airway pressure,airway platform pressure,and airway resistance in the study group were all decreased,the lung compliance and CMRO2 in the study group were both increased,and there was statistical significance at any time point compared with before treatment and with the control group(P<0.05).Conclusion Small dose aminophylline could improve cerebral oxygen metabolism and respiratory mechanics in patients with flail chest combined with respiratory failure,which has high clinical value.
作者
周志刚
黄斐
杨金良
张萌
黄刚
曹利娟
Zhou Zhi-gang;Huang Fei;Yang Jin-liang;Zhang Meng;Huang Gang;Cao Li-juan(Department of Thoracic Surgery,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2019年第11期1031-1035,共5页
Chinese Journal of Critical Care Medicine
基金
河北省医学科学研究重点课题计划(20160613)。
关键词
氨茶碱
连枷胸
呼吸衰竭
呼吸力学
氧代谢
Aminophylline
Flail chest
Respiratory failure
Respiratory mechanics
Oxygen metabolism
作者简介
周志刚(1980-),男,硕士研究生,主治医师,E-mail:1205888646@qq.com。
