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    徐雨晴, 武岩, 杨玉萍, 王姝婷, 刘苏. 静脉输注氨茶碱减轻老年全髋关节置换术患者术后肺部并发症:一项前瞻性双盲随机对照研究[J]. 徐州医科大学学报, 2022, 42(6): 396-401. DOI: 10.3969/j.issn.2096-3882.2022.06.002
    引用本文: 徐雨晴, 武岩, 杨玉萍, 王姝婷, 刘苏. 静脉输注氨茶碱减轻老年全髋关节置换术患者术后肺部并发症:一项前瞻性双盲随机对照研究[J]. 徐州医科大学学报, 2022, 42(6): 396-401. DOI: 10.3969/j.issn.2096-3882.2022.06.002
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    The pulmonary protective effects of aminophylline intravenous infusion on elderly patients under total hip arthroplasty[J]. Journal of Xuzhou Medical University, 2022, 42(6): 396-401. DOI: 10.3969/j.issn.2096-3882.2022.06.002
    Citation: The pulmonary protective effects of aminophylline intravenous infusion on elderly patients under total hip arthroplasty[J]. Journal of Xuzhou Medical University, 2022, 42(6): 396-401. DOI: 10.3969/j.issn.2096-3882.2022.06.002
    shu

    静脉输注氨茶碱减轻老年全髋关节置换术患者术后肺部并发症:一项前瞻性双盲随机对照研究

    The pulmonary protective effects of aminophylline intravenous infusion on elderly patients under total hip arthroplasty

      摘要
    • 摘要: 目的探讨围术期静脉输注氨茶碱对老年全髋关节置换术患者肺功能和术后肺部并发症的影响。方法选择279例择期行全麻下全髋关节置换术的老年患者，随机分为3组：对照组（C组，n=93），氨茶碱2.5 mg/kg组（A1组，n=94），氨茶碱5 mg/kg组（A2组，n=92）。A1组在麻醉诱导后即刻静脉泵注2.5 mg/kg氨茶碱，30 min泵完；A2组在相同的时间点静脉泵注5 mg/kg氨茶碱；C组泵注等体积的5%葡萄糖溶液。所有患者均行常规气管插管全麻。3组患者分别于麻醉诱导前（T0）、机械通气0.5 h（T1）、机械通气1 h（T2）、术毕（T3）行血气分析，并根据相应呼吸参数计算患者的肺动态顺应性（Cd）和静态顺应性(Cs)、氧合指数（OI）、肺泡-动脉氧分压差（A-aDO2）。同时记录机械通气时间、手术时间、术中液体输注情况、输血情况、苏醒时间、拔管时间、术后恢复质量及术后7 d肺部并发症发生率。结果3组患者在T0时刻，OI、A-aDO2的差异均无统计学意义（P＞0.05）。在T2、T3时间点，A1、A2组的OI、Cd和Cs高于C组，A-aDO2低于C组，差异均有统计学意义（P<0.05）；A2组OI、Cd、Cs高于A1组，A-aDO2低于A1组，差异均有统计学意义（P<0.05）。与C组相比，A1、A2组肺部并发症的发生率显著降低，且A2组的发生率比A1组更低 (P<0.05）。与C组相比，A1、A2组的苏醒时间和拔管时间显著缩短，拔管后低氧血症发生率也显著降低（P<0.05）；且A1组与A2组苏醒时间和拔管时间的差异亦有统计学意义。A1、A2组的15项恢复质量评分量表（QoR15）得分明显高于C组（P<0.05）。3组间术后恶心呕吐发生率无明显差异。结论全麻下静脉输注氨茶碱能显著改善老年全髋关节置换术患者围术期的肺通气和换气功能，显著降低患者肺部并发症的发生率，提高患者恢复质量。

       

      Abstract: 【ob＜x＞jective】 To investigate the effect of aminophylline intravenous infusion on lung function and postoperative pulmonary complications (PPCs) in elderly patients under total hip arthroplasty. 【Methods】 A total of 279 elderly patients who underwent total hip arthroplasty under general anesthesia were randomly divided into three groups: the control group (group C, n=93), the aminophylline 2.5 mg/kg group (A1 group, n=94), and the aminophylline 5 mg/kg group (A2 group, n=92). Group A1 received 2.5 mg/kg of aminophylline infusion immediately after anesthesia induction and the infusion time was 30 min. Group A2 received 5 mg/kg of aminophylline infusion at the same timepoint. Group C received the same volume 5% glucose solution. All patients received routine general anesthesia. The three groups of patients were analyzed for blood gases before anesthesia induction (T0), mechanical ventilation 0.5h (T1), mechanical ventilation 1h (T2), and after surgery (T3), and calculated the patients’ lung dynamic compliance (Cd) and static compliance (Cs), oxygen index (oxygen index, OI), alveolar-arterial oxygen difference (A-aDO2) according to the corresponding respiratory parameters. Meanwhile, the intraoperative fluid infusion, blood transfusion situation, awakening time, extubation time, the quality of postoperative recovery, and the incidence of PPCs in 7 days after surgery were also recorded.【Results】There were no significant differences in OI, A-aDO2, Cd, and Cs at T0. At T2 timepoint, the OI value in group A1 and A2 were significantly higher than that in group C （420.3±54.4 vs. 464.4±50.2 vs 356.7±47.3, mmHg）; A-aDO2 was significantly lower than that in group C (202.3±55.2 vs. 175.8±46.3 vs. 235.9±46.8, mmHg, ) ; and Cd and Cs were significantly higher than in group C (Cd: 36.4±6.7 vs. 41.2±7.1 vs. 30.2±5.9, ml/cmHO2). There was the same changes about above parameters at T3 timepoint. Besides, at T2 and T3 time points, there were also statistical differences between group A1 and group A2 in A-aDO2, Cd and Cs. Compared with group C, the incidence of PPCs in group A1 and group A2 was significantly reduced (21.5% vs.14.9% vs. 9.8% ), and the incidence of PPCs in group A2 was lower than that in group A1（9.8% vs. 14.9%）(P<0.05). Compared with group C, the wake-up time (12.4±3.5 vs. 9.5±2.4 vs.7.7±3.8, min ) and extubation time (20.7±5.4 vs.16.4±5.2 vs. 13.8±4.7, min) of group A1 and group A2 were significantly shortened, and the incidence of hypoxemia after extubation was also significantly reduced (7.5% vs. 3.2% vs. 2.2%) (P<0.05), and which were also significant different between group A1 and group A2. The QoR15 score in groups A1 and A2 were significantly higher than that in group C (P<0.05). There was no significant difference in the incidence of postoperative nausea and vomiting between the three groups.【Conclusion】 Intravenous aminophylline infusion can effectively improve the perioperative pulmonary ventilation and gas exchanging in elderly patients undergoing total hip arthroplasty, significantly reduce the incidence of PPCs in patients, and improve the quality of patient recovery.【Key words】 aminophylline; postoperative pulmonary complications; pulmonary function; total hip arthroplasty; elder

       

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