2024 年第 1 期 第 19 卷

不同剂量布地奈德预防肺叶切除术后肺部并发症的疗效与经济性评价

Efficacy and economic evaluation of different doses of budesonide for preventing pulmonary complications after pulmonary lobectomy

作者：何建荣1 武迪2 解达帅2 石萍2 牛钊峰3 段金菊4

英文作者：He Jianrong1 Wu Di2 Xie Dashuai2 Shi Ping2 Niu Zhaofeng3 Duan Jinju4

单位：1山西医科大学药学院，晋中030600；2山西省运城市中心医院药学部，运城044000；3山西省运城市中心医院医务科，运城044000；4山西医科大学第二医院药学部，太原030001

英文单位：1College of Pharmacy Shanxi Medical University Jinzhong 030600 China; 2Department of Pharmacy Yuncheng Central Hospital Shanxi Province Yuncheng 044000 China; 3Department of Medical Affairs Yuncheng Central Hospital Shanxi Province Yuncheng 044000 China; 4Department of Pharmacy Second Hospital of Shanxi Medical University Taiyuan 030001 China

关键词：肺叶切除术；术后肺部并发症；布地奈德；疗效评价；经济性

英文关键词：Pulmonarylobectomy;Perioperativepulmonarycomplications;Budesonide;Efficacyevaluation;Economy

• 摘要：

• 目的  探究不同剂量布地奈德预防肺叶切除术后肺部并发症（PPCs）的疗效及用药的经济性。方法  收集2021年1月至2022年12月在山西省运城市中心医院行肺叶切除术的160例患者资料进行回顾性分析，根据术后吸入用布地奈德混悬液剂量不同分为高剂量组（日剂量＞4 mg，H组，62例）、低剂量组（日剂量≤4 mg，L组，98例），记录患者的基本信息。比较2组PPCs发生率、胸部引流管留置时间、咳痰无力持续天数、术后住院天数、术后抗菌药物费用及使用量、术后医疗及药品费用、术后药占比。采用单因素和多因素Logistic回归方法分析PPCs的危险因素。结果  2组PPCs发生率、胸部引流管留置时间、术后住院时长比较，差异均无统计学意义（均P＞0.05），H组咳痰无力持续天数少于L组［2（2,2）d比2（2,3）d］（P＜0.05）。肺部感染患者中，2组抗菌药物治疗费用及累计用药频度比较，差异均无统计学意义（均P＞0.05）。2组术后医疗费用、药品费用及药占比比较，差异均无统计学意义（均P＞0.05）。多因素Logistic回归显示，有吸烟史、健康状况差、手术时间长、气道管理三联用药方案为PPCs的独立危险因素(均P＜0.01)。结论  高剂量布地奈德在预防PPCs的疗效及经济性方面均无显著优势，建议参考说明书日最大剂量4 mg给药；含多索茶碱的四联干预方案可明显降低PPCs发生率，建议纳入气道管理方案。

• Objective  To investigate the efficacy and economic efficacy of different doses of budesonide in preventing pulmonary complications (PPCs) after pulmonary lobectomy. Methods  The data of 160 patients who underwent pulmonary lobectomy in Yuncheng Central Hospital, Shanxi Province from January 2021 to December 2022 were retrospectively analyzed. According to the different doses of budesonide suspension after surgery, patients were divided into high-dose group (daily dose ＞4 mg, group H, 62 cases) and low-dose group (daily dose≤4 mg, group L, 98 cases). The basic information of patients was recorded. The incidence of PPCs, retention time of thoracic drainage tubes, duration of sputum weakness, postoperative length of stay, postoperative cost and usage of antibiotics, postoperative medical and drug costs, and postoperative drug proportion of the two groups were compared. Univariate and multivariate Logistic regression models were used to analyze the risk factors affecting PPCs. Results  There were no statistically significant differences in the incidence of PPCs, retention time of thoracic drainage tubes, and postoperative length of stay between the two groups (all P＞0.05). The duration of sputum weakness in group H was shorter than that in group L［2（2,2）d vs 2（2,3）d］(P＜0.05). For patients with pulmonary infection, there were no statistically significant differences in the treatment cost and cumulative defined daily dose of antibiotics between the two groups (all P＞0.05). There were no statistically significant differences in postoperative medical costs, drug costs and drug proportion between the two groups (all P＞0.05). The multivariate Logistic regression results showed that smoking history, poor health status, long surgical time, and triple medication plan of airway management combined with medication regimen were independent risk factors for PPCs (all P＜0.01). Conclusions  High-dose budesonide has no significant advantage in preventing PPCs, and it is recommended to refer to the instructions for daily maximum dose of 4 mg. Quadruple interventions containing doxofylline significantly reduce the incidence of pulmonary complications and are recommended for airway management.