Effects of penehyclidine inhalation on postoperative pulmonary complications of elderly patients after long-duration surgery

目的 探讨老年患者长时间手术后雾化吸入戊乙奎醚对肺部并发症发生率的影响.方法 本研究是前瞻性、双盲、随机对照研究,入选2012年2月14日至9月13日在全身麻醉下接受长时间(≥3 h)手术后进入北京大学第一医院重症监护病房(ICU)的90例老年患者,患者拔管后按随机数字表法随机分为3组,分别接受戊乙奎醚、异丙托溴铵和生理盐水雾化吸入,连续3d.主要观察指标为3组患者拔管后6d内肺部并发症的发生率.结果 戊乙奎醚组、异丙托溴铵组和生理盐水组支气管痉挛发生率分别为3.3％、3.2％、20.7％,氨茶碱的使用率分别为0、0、10.3％,前2组均显著低于生理盐水组(P=0.025和P=0.038);术后6d内无气管痉挛时间分别为5.8(5.5 ～6.2)d、5.8(5.5 ～6.2)d、5.3(4.8～5.9)d,前2组显著长于生理盐水组(P=0.028);术后总的肺部并发症发生率分别为70.0％、71.0％、75.9％(P=0.865).结论 老年患者长时间手术拔管后雾化吸入戊乙奎醚可降低气管痉挛的发生率、减少氨茶碱的使用率,但对总的肺部并发症发生率无显著影响.Objective To explore the effects of penehyclidine inhalation on the incidence of pulmonary complications in elderly patients after long-duration surgery.Methods For this prospective,double-blind and randomized controlled trial,90 elderly patients undergoing long-duration surgery (≥ 3hours) under general anesthesia and transferred into intensive care unit (ICU) of Peking University First Hospital during February 14,2012 to September 13,2012 were enrolled.After extubation,they were randomized into 3 groups to receive an inhalation of penehyclidine hydrochloride,ipratropium bromide or normal saline for 3 consecutive days.The primary endpoint was the incidence of pulmonary complications within 6 days post-extubation.Results The incidence of bronchospasm was 3.3％,3.2％ and 20.7％respectively.And the rate of aminophylline use was 0,0 and 10.3％ respectively (P =0.025 and P =0.038) ; the airway tract spasm-free duration within 6 days after extubation was 5.8 (5.5-6.2),5.8(5.5-6.2) and 5.3 (4.8-5.9) days (P =0.028) ; the overall incidence of pulmonary complications was 70.0％,71.0％ and 75.9％ (P =0.865).Conclusions For elderly patients after long-duration surgery,a prophylactic atomizing inhalation of penehyclidine decreases the incidence of bronchospasm and the rate of aminophylline use after extubation.However,the overall incidence of pulmonary complications has no change.PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)02122-1269