沐舒坦循证医学证据.pptxVIP

沐舒坦围手术期肺保护循证医学证据; 肺脏是体内唯一一个接受全部心输出血量,也是全身静脉血必经的巨型滤器;同时肺脏也是一个开放的器官,这使得肺脏易受到内源性和外源性有害因素的作用而受到损伤.术前危险因素.手术.麻醉.输血.心肺转流以及其他医疗措施等均可在围手术期对肺脏造成一定的损伤,发生围手术期各种肺部合并症.严重者发生呼吸功能不全,威胁患者生命安全.因此,围手术期肺保护措施,预防和治疗肺部并发症非常重要,是外科手术患者快速康复的有力保证.;外科手术后肺部并发症;Postoperative pulmonary complications ;Smoking;;围手术期肺部并发症发病率高（上腹部手术）;;Jorissen M. Am J Rhino 1998; 12:53-8. ambroxol对危重患者肺功能的保护 中华急救医学2001，21（1）;麻醉药;围手术期肺保护;术前确切评估患者是否需要加强肺保护;;术前评估术后肺部并发症风险;肺保护措施;Pearl JM, et al. Ann Thorac Surg, 2004, 77(3): 994-1000;Pearl JM, et al. Ann Thorac Surg, 2004, 77(3): 994-1000;沐舒坦1、2 1、Refai M, et al. . Short-term perioperative treatment with ambroxol reduces pulmonary complications and hospital costs after pulmonary lobectomy:a randomized trial. Eur J Cardiothorac Surg, 2009, 35(3):469-473. 2、Ulas MM, et al. Protective effect of ambroxol on pulmonary function after cardiopulmonary bypass. J Cardiovasc Pharmacol, 2008, 52(6): 518-523 乌司他丁（ulinastatin）3 3、谢波,等. 乌司他丁对深低温停循环下主动脉手术患者肺保护的研究. 中国胸心血管外科临床杂志, 2009（待发） 钙蛋白酶抑制剂（calpain inhibition）4 4、Jodie YD, et al. Calpain inhibition decreases endothelin-1 levels and pulmonary hypertension after cardiopulmonary bypass with deep hypothermic circulatory arrest. Crit Care Med, 2005, 33(3): 623-628 糖皮质激素（glucocorticoids）5 5、Pearl JM, et al. Preoperative glucocorticoids decrease pulmonary hypertension in piglets after cardiopulmonary bypass and circulatory arrest. Ann Thorac Surg, 2004, 77(3): 994-1000. N-乙酰半胱氨酸（N-acetylcysteine）6 6、Omer C, et al. N-acetylcysteine reduces lung reperfusion injury after deep hypothermia and total circulatory arrest. J Card Surg, 2004, 19: 221-22 ;;;Ambroxol 肺保护中的5个功能;常规剂量——支气管粘膜效应;刺激肺泡II型细胞合成、分泌 表面活性物质;患者筛选 VSD CPB Ambrosol: n = 17 30mg/kg/d 术前3d Control: n = 15 none ;Short-term perioperative treatment with ambroxol reduces pulmonary complications and hospital costs after pulmona