乙酰半胱氨酸雾化联合肺泡灌洗治疗胸科术后肺不张的临床效果

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摘要目的探讨应用吸入型乙酰半胱氨酸（NAC）联合纤支镜肺泡灌洗术对胸科术后肺不张患者的疗效。方法选取2015年1月～2019年5月我院收治的60 例胸科术后肺不张需行机械通气患者进行回顾性分析，根据治疗方法的不同将其分为对照组和治疗组，每组各30 例。对照组患者予灭菌注射用水雾化+灭菌注射用水灌洗；治疗组患者予NAC 雾化+NAC 稀释液灌洗。比较两组患者治疗前以及治疗1、3、7 d 后的白细胞（WBC）、降钙素原（PCT）、氧合指数（OI）、氧分压（PaO2）、二氧化碳分压（PaCO2）变化，比较两组患者的肺部啰音消失时间及机械通气时间。结果治疗后1、3、7 d，两组患者的OI、PaO2 高于本组治疗前，差异有统计学意义（P＜0.05）。治疗组患者治疗3、7 d 后的OI、PaO2 高于对照组，差异有统计学意义（P＜0.05）。两组患者治疗后1、3、7 d 的PaCO2 低于治疗前，差异有统计学意义（P＜0.05）。两组患者治疗1、3、7 d 后的PaCO2 比较，差异无统计学意义（P＞0.05）。治疗组患者治疗3、7 d 后的PCT 低于对照组，差异有统计学意义（P＜0.05）。两组患者治疗3、7 d 后的WBC 比较，差异无统计学意义（P＞0.05）。治疗组患者的肺部啰音消失时间及机械通气时间短于对照组，差异有统计学意义（P＜0.05）。结论应用NAC 行肺泡灌洗术能使胸科术后肺不张患者改善肺通气换气功能，控制肺部感染症状，使患者获益。

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关键词 ：胸科术后, 肺不张, 肺泡灌洗术, 乙酰半胱氨酸

Abstract：Objective To investigate the curative effect of applying inhaled N-acetylcysteine (NAC) combined with fiberoptic bronchial alveolar lavageon patients with atelectasis after thoracic surgery. Methods A retrospective analysis was performed in 60 patients with atelectasis after operation needing mechanical ventilation. They were treated in our hospital from January 2015 to May 2019. According to different treatments, all participants were divided into the control group (n=30) and treatment group (n=30). In the control group, the patients were treated with aseptic injectable water for both the atomized inhalation and lavage. In the treatment group, the patients were treated with both NAC for atomized inhalation and NAC diluent for lavage. The changes of white blood cells (WBC), procalcitonin (PCT), oxygenation index (OI), oxygen partial pressure (PaO2) and carbon dioxide partial pressure (PaCO2) were measured before treatment and at the first day, third day and seventh day after treatment. The disappearance time of the lung rales and the time used for mechanical ventilation were compared. Results At the first day, third day and seventh day after treatment, the OI and PaO2 of patients in the two groups were higher than those before treatment, and the differences were statistically significant (P＜0.05). The OI and PaO2 in the treatment group at the third day and seventh day after treatment were higher than those in the control group, with statistically significant differences (P＜0.05). The PaCO2 at the first day, third day and seventh day after treatment of the two groups were lower than those before treatment, and the differences were statistically significant (P＜0.05). At the first day, third day and seventh day after treatment, there were no significant difference in PaCO2 between the two groups (P＞0.05). The PCT at the third day and seventh day after treatment in the treatment group were lower than those in the control group, and the differences were statistically significant (P＜0.05). There were no significant differences in WBC at the third day and seventh day after treatment between the two groups (P＞0.05). The disappearance time of the lung rales and the time used for mechanical ventilation in the treatment group were shorter than those in the control group, with statistically significant differences (P＜0.05). Conclusion The application of NAC for alveolar lavage can improve the functions of lung ventilation and breathing in patients with atelectasis after thoracic surgery, and control the symptoms of pulmonary infection, which is beneficial for patients.

Key words： Post-thoracic surgery Atelectasis Alveolar lavage N-acetylcysteine

基金资助:广东省江门市医疗卫生科技计划项目（2018B011）

引用本文:

杨杰章；刑巧睿；邓淑娟. 乙酰半胱氨酸雾化联合肺泡灌洗治疗胸科术后肺不张的临床效果[J]. 中国当代医药, 2020, 27(6): 46-49.
YANG Jie-zhang XING Qiao-rui DENG Shu-juan. Clinical effect of N-acetylcysteine aerosol combined with alveolar lavage in the treatment of atelectasis after thoracic surgery. 中国当代医药, 2020, 27(6): 46-49.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2020/V27/I6/46

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