Effects Of Different Dosage Of Ambroxol On Lung Protection In Perioperative Thoracotomy

Objective Detect the serum markers (surfactant-associated protein A, intercellular adhesion molecule, malondialdehyde, superoxide dismutase) and clinical examination indexes (pulmonary function, arterial blood gas) of the postoperative thoracotomy patients, in order to research the relation between the markers above and the usage of mucosolvan with different dosage. So as to provide new evidence for the clinical usage of ambroxol in the patients undergoing thoracotomy.Methods (1) Collected80cases of thoracotomy patients of XiangYahospital during2011.05-2012.02.(2) Based on the method of randomized grouping double-blind,blank control.Divided the patients sellected into four groups (A,B,C,D). group A is blank controled group (without using drugs); group B is small dosage group (3mg/(kg.d)); group C is middle dosage group (9mg/(kg.d)); group D is large dosage group (15mg/(kg.d)).To use corresponding dosage of ambroxol (2ml:15ml) on three days before the surgery to three days after the surgery, altogether six days.(3) Testing the arterial blood gas on pre-test (T1a),intraopration (T1b),the sixth days of the test (T1c), and record the level of oxygen partial pressure (PaO2, mmHg); Testing the pulmonary function on pre-test (T2a),intraopration (T2b),the sixth days of the test (T2c), and record the level of FEV1/FVC; Testing the SP-A on pre-test (T3a), intraopration (T3b),30minutes after the surgery (T3c), the sixth days of the test (T3d); Testing the level of MDA,SOD,ICAM-1on pre-test (T4a),intraopration (T4b),two hours after surgery (T4c),the sixth days of the test (T4d)(4) Test the level of SP-A,MDA,SOD by the mean of Enzyme-linked Immunosorbent Assay.(5) Stafistical analysis was performed using SPSS statistical software package (17.0). P values≤0.05indicated statistically significant difference.Results (1) PaO2:At the moment of T1a and T1b, the level of PaO2in ABCD group is no significant difference with each other(P>0.05); at T3c, there is no significant difference (P>0.05) at the level of PaO2in group A compared with group B and group C compared with group D, group A compared with group C and group D had statistical differences (P<0.05); group B compared with group C and D had statistical differences (P<0.05).(2) FEV1/FVC:Between any two of the T2a, T2b time the FEV1/FVC level, group ABCD had no significant difference with each other (P>0.05); the FEV1/FVC level at T3c time, Group BCD was higher than that in group A (P>0.05), Group B had no significant difference compared with group C (P>0.05); group D was higher than group BC(P <0.05).(3) SP-A:At T3b T3c and T3d, the SP-A of group BCD was lower compared with group A (P<0.05); at T3b and T3c, the level of SP-A in group B and group C, group C and group D, group B and group D had no significant difference (P>0.05); at T3d, the level of SP-A in group D was significantly lower than group B and group C (P<0.05), there was no significant difference between group C and group B (P>0.05).(4) ICAM-1,SOD. MDA:At T4b T4c T4d, the content of MDA and ICAM-1in group A was significantly higher than that of group BCD,and the level of SOD was significantly higher (P<0.05). At T4b T4c T4d,the content of MDA and ICAM-1in group D was lower than that of group BC, and the level of SOD was significantly higher (P<0.05). At T4b T4c T4d moment,there was no significant difference of ICAM-1, MDA. SOD between group C and group B (P>0.05).Conclusion (1) Small dose ambroxol application in perioperation had no significant effect on the perioperative period in patients with arterial oxygen tension levels, while medium dose and high-dose application of ambroxol can improve the postoperative blood oxygen levels, and has the same effect both.(2) Perioperative application of ambroxol can effectively improve the level of FEV1/FVC postoperative, thereby improving lung compliance, the improvement is more obvious while use large dose of ambroxol.(3) The perioperative ambroxol may reduce the level of SP-A in peripheral blood, large doses of ambroxol application preoperative and postoperative30min to reduce the role of SP-A levels is not obvious, and within three days after surgery, can significantly reduce SP-A level, and the analysis of the inflammatory factors, anti-inflammatory factors and peripheral blood SP-A levels indicates that the Inflammatory response and SP-A in peripheral blood are not positively correlated.(4) Ambroxol can regulate the content of MDA,SOD and ICAM-1effectively, thus play the role of anti-inflammatory and antioxidant, its onset time is less than three days, the anti-inflammatory, anti-oxidation effect is more obvious while large dose application.