Abstract:

Objective　To observe the effect of aerosol inhalation of ultrafine particle size pentylenethyclidine hydrochloride (PHC) on airway injury in patients after laryngeal mask general anesthesia who take endobronchial ultrasound-guided needle aspiration (EBUS-TBNA), and to analyze its mechanism of action. Methods　One hundred and twenty-six patients who took EBUS-TBNA at Henan Provincial People's Hospital from January 2021 to January 2022 were selected for the randomized controlled trial, and were divided into an observation group and a control group by the random number table method, with 63 cases in each group. There were 33 males and 30 females in the observation group; they were 38-72 (55.62±5.69) years old. There were 32 males and 31 females in the control group; they were 40-70 (56.33±5.25) years old. The observation group received nebulized inhalation of ultrafine particle size PHC as the auxiliary laryngeal mask general anesthesia. The control group received dihydroxypropaphylline injection as the auxiliary laryngeal mask general anesthesia. The inflammatory indicators, airway morphological indicators, and changes in ventilation function before and after the surgery and occurrences of postoperative airway injury were compared between the two groups.t and χ² tests were used. Results　After the surgery, the levels of interleukin-13 (IL-13), tumor necrosis factor-α (TNF-α), and fractional exhaled nitric oxide (FeNO) in the observation group were lower than those in the control group [(6.13±2.21) ng/L vs. (8.33±2.45) ng/L, (7.22±2.15) ng/L vs. (9.36±2.77) ng/L, and (23.32±2.17) ppb vs. (26.61±5.41) ppb], with statistical differences (t=5.29, 4.84, and 4.48; all P<0.05). After the surgery, the bronchial basement membrane perimeter (Pbm), total thickness of airway wall, and thickness of airway smooth muscle in the observation group were lower than those in the control group [(1.77±0.24) cm vs. (2.16±0.38) cm, (7.15±2.41) mm²/mm vs. (9.24±2.25) mm²/mm, and (3.44±0.58) mm²/mm vs. (4.41±1.27) mm²/mm], with statistical differences (t=6.89, 5.03, and 5.52; all P<0.05). The forced expiratory volume in the first second, peak expiratory flow (PEF), and forced vital capacity (FVC) in the observation group were higher than those in the control group [(85.22±10.46)% vs. (78.25±10.13)%, (422.74±80.61) L/min vs. (378.25±80.24) L/min, and (2.68±0.46) L vs. (1.92±0.74) L], with statistical differences (t=3.80, 3.11, and 6.92; all P<0.05). After the surgery, the incidence of airway injury in the observation group was lower than that in the control group [9.52% (6/63) vs. 20.63% (13/63)], with a statistical difference (χ²=4.82, P<0.05). Conclusions　Nebulized inhalation of ultrafine particle size PHC assisted laryngeal mask general anesthesia can effectively improve postoperative airway inflammation and ventilation function in patients who take EBUS-TBNA. The mechanism is related to inhibiting airway smooth muscle proliferation and promoting airway morphological recovery.

Key words:

Endobronchial ultrasound-guided transbronchial needle aspiration, Pentylenethyclidine hydrochloride, Airway,  , Injury, Inflammatory reaction

摘要：

目的　观察雾化吸入超微粒径盐酸戊乙奎醚（PHC）对超声引导下经支气管针吸活检（EBUS-TBNA）患者喉罩全麻后气道损伤的影响，并分析其作用机制。方法　选取河南省人民医院2021年1月至2022年1月收治的126例行EBUS-TBNA的喉罩全麻患者进行随机对照试验，以随机数字表法将其分为观察组和对照组，各63例。观察组男33例，女30例，年龄38～72（55.62±5.69）岁，采用经雾化吸入超微粒径PHC辅助喉罩全麻；对照组男32例，女31例，年龄40～70（56.33±5.25）岁，采用二羟丙茶碱注射液辅助喉罩全麻。比较两组患者治疗前后的炎症指标、气道形态学指标、通气功能变化情况，以及术后气道损伤发生情况。采用t检验、χ²检验。结果　术后，观察组的白细胞介素-13（IL-13）、肿瘤坏死因子-α（TNF-α）、呼出气一氧化氮（FeNO）均低于对照组［（6.13±2.21）ng/L比（8.33±2.45）ng/L、（7.22±2.15）ng/L比（9.36±2.77）ng/L、（23.32±2.17）ppb比（26.61±5.41）ppb］，差异均有统计学意义（t=5.29、4.84、4.48，均P<0.05）。术后，观察组的支气管基底膜周径（Pbm）、气道壁总厚度、气道平滑肌厚度均低于对照组［（1.77±0.24）cm比（2.16±0.38）cm、（7.15±2.41）mm²/mm比（9.24±2.25）为mm²/mm、（3.44±0.58）mm²/mm比（4.41±1.27）mm²/mm］，差异均有统计学意义（t=6.89、5.03、5.52，均P<0.05）。术后，观察组的第一秒用力呼气量（FEV1）、呼气流量峰值（PEF）、用力肺活量（FVC）均高于对照组［（85.22±10.46）%比（78.25±10.13）%、（422.74±80.61）L/min比（378.25±80.24）L/min、（2.68±0.46）L比（1.92±0.74）L］，差异均有统计学意义（t=3.80、3.11、6.92，均P<0.05）。术后，观察组的气道损伤发生率低于对照组［9.52%（6/63）比20.63%（13/63）］，差异有统计学意义（χ²=4.82，P<0.05）。结论　雾化吸入超微粒径PHC辅助喉罩全麻能有效改善EBUS-TBNA患者术后气道炎症反应及通气功能，其机制考虑与抑制气道平滑肌增殖、促进气道形态学恢复相关。

关键词:

超声引导下经支气管针吸活检, 盐酸戊乙奎醚, 气道, 损伤, 炎症反应