Li Wenjing, Zhao Yu, Sun Zhijian, Yang Xu, Zhao Lijuan, Shen Jianxiong
Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
J Thorac Dis. 2014 Dec;6(12):1800-7. doi: 10.3978/j.issn.2072-1439.2014.12.36.
To determine the pulmonary protective effect of budesonide nebulization in patients undergoing spinal fusion for thoracolumbar degenerative disorders.
Forty patients who underwent spinal fusion at our hospital from January 2013 to December 2013 for the treatment of thoracolumbar degenerative disorders were randomly allocated into a budesonide intervention group (budesonide group) and a control group. The control group received routine supportive therapy including rehydration, analgesia, and neurotrophic drug treatment; in addition to these, the budesonide group was administered with budesonide nebulization (1-mg budesonide/2-mL saline, twice daily) from 1 day preoperatively through 3 days postoperatively. Respiratory symptoms, arterial blood gas, and pulmonary complication before and after the operations were observed and compared between the two groups.
The patients ranged in age from 46 to 81 years old (mean, 62.4±9.4 years), and comprised 20 men and 20 women. There were no significant differences in postoperative body temperature, heart rate, and respiratory rate between the groups (P>0.05). The change in arterial partial pressure of oxygen (PaO2) from baseline was significantly lower in the budesonide group than in the control group (at 2.4±12.4 vs. 16.0±11.3 mmHg) (P=0.002), so was the findings for oxygen saturation (SpO2) (0.2%±2.3% vs. 2.6%±3.3%), respectively (P=0.047). The incidence of postoperative pulmonary symptoms and complications, such as coughing, shortness of breath, and dyspnea, was 0% in the budesonide group and 15% in the control group; overall, the budesonide group performed better than control group in all pulmonary parameters. None of the patients in the budesonide group experienced severe events associated with glucocorticoid therapy.
Perioperative budesonide nebulization may reduce the postoperative pulmonary complications in middle-aged and elderly patients undergoing thoracolumbar fusion to treat thoracolumbar degeneration, with favorable efficacy and safety.
确定布地奈德雾化吸入对胸腰椎退变性疾病行脊柱融合术患者的肺保护作用。
选取2013年1月至2013年12月在我院因胸腰椎退变性疾病行脊柱融合术的40例患者，随机分为布地奈德干预组（布地奈德组）和对照组。对照组接受包括补液、镇痛及神经营养药物治疗在内的常规支持治疗；布地奈德组除上述治疗外，于术前1天至术后3天给予布地奈德雾化吸入（1mg布地奈德/2mL生理盐水，每日2次）。观察并比较两组患者手术前后的呼吸道症状、动脉血气及肺部并发症情况。
患者年龄46至81岁（平均62.4±9.4岁），男20例，女20例。两组患者术后体温、心率及呼吸频率比较，差异无统计学意义（P>0.05）。布地奈德组术后动脉血氧分压（PaO2）较基线的变化值显著低于对照组（分别为2.4±12.4 mmHg和16.0±11.3 mmHg）（P=0.002），血氧饱和度（SpO2）的变化值情况亦如此（分别为0.2%±2.3%和2.6%±3.3%）（P=0.047）。布地奈德组术后肺部症状及并发症（如咳嗽、气短、呼吸困难）的发生率为0%，对照组为15%；总体而言，布地奈德组在所有肺部参数方面表现均优于对照组。布地奈德组患者均未发生与糖皮质激素治疗相关的严重事件。
围手术期布地奈德雾化吸入可降低中老年胸腰椎退变性疾病行脊柱融合术患者术后肺部并发症的发生，疗效及安全性良好。
