The Influence Of Budesonide Suspension For Inhalation On Respiratory System For Esophageal Or Cardiac Cacinoma During The Perioperation

Objective: Esophageal or cardiac cacinoma is one of the most malignant tumor of the digestive system,both of the incidence rate and death rate are high.Claiming approximately 200 000 deaths in china,the deaths account for nearly half of the total deaths in the world.Nowadays there are many treatment options for esophageal or cardiac cacinoma,surgery is the first and most important choice for patients with esophageal or cardiac cacinoma at early or intermediate stage,because it can resection the tumor and dissect the regions' s lymphatic metastasis,the long-term survival time is better.Because of the specificity of anatomical position,the surgery of esophageal or cardiac cacinoma inflict great suffering on the bodies,the operation time is long,the incidence of postoperative complication is higher and the risks is also higher.Due to the improvement of operative approach,the rate of anastomotic leakage goes down every year,respiratory complications are the most common complications for esophageal or cardiac cacinoma during the perioperation,occurs up to 20%-30%,it can severely affect the patients' s recovery,respiratory failure is the main reason of the perioperative death.Through the efforts of the scholars at home or abroad,the risk factors about respiratory complications after esophageal or cardiac cacinoma operation had been illuminated,but the study of the prevention and control measures made little progress.Respiratory management is one of the major content with patient perioperative management after esophageal or cardiac cacinoma operation.Airway inflammation is the key point of postoperative respiratory complications,if prevention and control measures be adopted it can reduce the incidence rate of respiratory complications.Budesonide is one oe the inlaled corticosteroids(ICS),which with powerful anti-inflammatory effect in airway location,it's safe and effective.It has been widely used in the management of exacerbations of bronchial asthma and COPD to control diseased conditions.However there are only a few studies in the literature related to the influence on respiratory system complications for esophageal or cardiac cacinoma during the perioperation to the patients who without bronchial asthma and COPD.So the authors design a study to research apllying the budesonide suspension for inhalation before and after operation in the esophageal or cardiac cacinoma patients who had accepted left thoracic one incision surgery,observe if it can reduce patient's operative risk and the incidence rate of postoperative respiratory complications.Methods: The patients with esophageal or cardiac cacinoma were recruited from The 4th Affiliated Hospital of Hebei Medical University between January 2014 and January 2015,who had accepted left thoracic one incision surgery were observed,they were divided randomly into two groups: A group(control group),the patients inhaled aerosol ambroxol hydrochloride 30 mg bid 3 days before operation,and they also inhaled aerosol ambroxol hydrochloride 30 mg one hour before anethesia,after operation they inhaled aerosol ambroxol hydrochloride 30 mg qid until to the seventh day.B group(study group),the patients inhaled aerosol ambroxol hydrochloride 30 mg and budesonide suspension for inhalation 1mg bid 3 days before operation,they also inhaled aerosol ambroxol hydrochloride 30 mg and budesonide suspension for inhalation 1mg one hour before anethesia,after operation they inhaled aerosol ambroxol hydrochloride 30 mg qid and budesonide suspension for inhalation 1mg bid until to the seventh day.The changes of arterial blood gases analysis(Oxygen partial pressure PaO2?Carbon dioxide partial pressure PaCO2)were measured.The patient's peak airway pressure(Ppeak)?plat airway pressure(Pplat)and lung compliance(CL)were recorded at the balanced general anesthesia time(T1)?after one lung ventilation time(T2)and recovered two lung ventilation time(T3),evaluating if they have significant difference by statistical analysis.The time of extubation after operation also be recorded and be analyzed.The scores of sputum viscosity of the two groups was compared.The cases and incidence of pneumonia?atelectasis?respiratory failure were analyzed.The scores of lung dry rale was recorded and analyzed.SPSS13.0 statistical software package was used for all analyses.Descriptive ststistics(x±s)were used to summarize the measurement data.Compared with the data in the same group used the matching t-test,compared with the data between used the independent samples t-test.The count data was described by frequency or rate,it was compared by chi-square.P values<0.05 were considered to be statistically significient.Results: The study contained a total of 187 patients,among them A group(control group)had 96 patients,B group(study group)had 91 patients.There was no statistical difference(P values>0.05)in the general condition such as age range?gender? operation method?pulmonary function indexing and so on.1 Arterial blood gases analysis before and after aerosol inhalation.Before aerosol inhalation there was no statistical difference(P values>0.05)in both oxygen partial pressure(PaO2)and carbon dioxide partial pressure(PaCO2).Both the two group's PaO2 gone up after aerosol inhalation and there was statistical difference(P values<0.05)compared to pre-aerosol inhalation,but there was no statistical difference(P values>0.05)in PaCO2.between the two groups there were no statistical difference(P values>0.05)in both PaO2 and PaCO2 after aerosol inhalation.2 At any T1?T2?T3 time point,there were no statistical difference(P values>0.05)in peak airway pressure(Ppeak)plat airway pressure(Pplat)and lung compliance(CL).There was no statistical difference(P values>0.05)in the time of extubation after operation.3 The scores of sputum viscosity of B group(study group)was lower than A group(control group),there was statistical difference(P values=0.018)in the scores of sputum viscosity.The incidence rate of atelectasis of B group(study group)was lower than A group(control group),it was significant difference between the two groups(P values=0.040).There were no statistical difference(P values>0.05)in the incidence rate of pneumonia?respiratory failure and the scores of lung dry rale.Conclusion: The application of budesonide suspension for inhalation in the patients with esophageal or cardiac cacinoma who underwent left thoracic one incision surgery is effective,it can be used by atomization inhalation measure in perioperative period.Budesonide suspension for inhalation can reduce the sputum viscosity and the incidence rate of atelectasis,it is beneficial to reduce postoperative respiratory system complications and the risk of operation,it is meaningful for clinical application.