Effects of Budesonide Aerosol Inhalation on Perioperative Lung Function in Patie

Yongliang CHEN, Jing XUE, Daguang FANG, Xiaoli YAN, Xuefei TIAN, Shulei XU

1.Affiliated Hospital of Chengde Medical College, Chengde 067000, China; 2.Chengde Medical College, Chengde 067000, China

Abstract [Objectives]To explore the effects of budesonide aerosol inhalation on the perioperative pulmonary function of patients undergoing cardiopulmonary bypass valve replacement.[Methods]A total of 82 patients who underwent cardiopulmonary bypass valve replacement during January 2018 and May 2019 in the Affiliated Hospital of Chengde Medical College were selected.They were divided into blank control group(group A, n=28), aerosol control group(group B, n=27, normal saline aerosol treatment), and experimental group(group C, n=27, budesonide aerosol treatment)by the random number table method.Corresponding treatments were given 5 d before surgery and 5 d after surgery, and the treatment effects of the 3 groups were compared.[Results]The clinical symptom scores of the patients in the experimental group were significantly lower than those in the blank control group and the aerosol control group, and the total effective rate of treatment was significantly higher than that in the blank control group.[Conclusions]Perioperative application of budesonide aerosol inhalation can effectively improve the clinical symptoms, treatment effect, and clinical prognosis of patients undergoing cardiopulmonary bypass valve replacement.

Key words Cardiopulmonary bypass, Valve replacement, Aerosol inhalation, Lung function

1 Introduction

The operation of cardiac valve replacement surgery is complicated.Due to the influence of general anesthesia, cardiopulmonary bypass, ventilator assistance, thoracic trauma and other factors, almost all patients after surgery have varying degrees of weakening respiratory function, reduced lung compliance, lung tissue congestion and edema, and so on[1].The degree of clinical manifestations is different, from undetectable mild injuries to acute respiratory distress syndrome(ARDS)[2-3], and even acute respiratory failure(ARF).Some studies indicate that lung injury after cardiopulmonary bypass(CPB)generally recovers gradually within one week after surgery[4], but still 2% to 3% patients had ARDS after surgery, and the mortality rate is as high as 50%.In addition, nearly 20% of patients after CPB require mechanical ventilation for more than 48 h[5].Therefore, in the perioperative period of cardiopulmonary bypass valve replacement, aerosol treatment is applied to patients to improve their lung function and promote their recovery.The budesonide aerosol inhalation is a common method for the treatment of respiratory diseases.We selected 82 patients undergoing cardiopulmonary bypass valve replacement in the Affiliated Hospital of Chengde Medical College to explore the effect of budesonide aerosol on the perioperative lung function of patients undergoing cardiopulmonary bypass valve replacement.

2 Data and methods

2.1 General dataWe selected a total of 82 patients who underwent cardiopulmonary bypass valve replacement during January 2018 and May 2019 in the Affiliated Hospital of Chengde Medical College and divided them into blank control group(group A,n=28), aerosol control group(group B,n=27, normal saline aerosol treatment), and experimental group(group C,n=27, budesonide aerosol treatment)by random number table method.In group A, there were 12 male and 16 female patients; they were 37-69 years old, with an average of(58±7.4)years old; cardiac function(NYHA classification): 1 case was grade II, 27 cases were grade III; 9 cases were aortic valve replacement, 15 cases were mitral valve replacement, and 4 cases were double valve replacement; cardiopulmonary bypass time(88±27)min; arrest time(52±9)min; oxygenation index(325±11)mmHg, alveolar-arterial oxygen partial pressure difference(31±3.6)mmHg.In group B, there were 15 male and 12 female patients; they were 37-67 years old, with an average of(57±7.4)years old; cardiac function(NYHA classification): 2 cases were grade II, 25 cases were grade III; 6 cases were aortic valve replacement, 14 cases were mitral valve replacement, and 7 cases were double valve replacement; cardiopulmonary bypass time(90±29)min; arrest time(52±8)min; oxygenation index(323±10)mmHg, alveolar-arterial oxygen partial pressure difference(32±2.4)mmHg.In group C, there were 10 male and 17 female patients; they were 37-69 years old, with an average of(56±6.0)years old; cardiac function(NYHA classification): 2 cases were grade II, 25 cases were grade III; 2 cases were aortic valve replacement, 15 cases were mitral valve replacement, 1 case was tricuspid valve replacement, 9 cases were double valve replacement; cardiopulmonary bypass time(91±28)min; arrest time(52±11)min; oxygenation index(327±15)mmHg, alveolar-arterial oxygen partial pressure difference(31±3.1)mmHg.The general data of the 3 groups of patients were not statistically significant(P>0.05).The study was approved by the Ethics Committee of the Affiliated Hospital of Chengde Medical College, and the patients were informed and expressed the consent to the study.

2.2 Inclusion and exclusion criteria(i)Inclusion criteria: first time undergoing cardiopulmonary bypass valve replacement; age ≥18 years old; cardiac function grade II-III.(ii)Exclusion criteria: patients with severe pulmonary insufficiency; patients with chronic obstructive pulmonary disease; patients with acute upper respiratory tract infection within 2 weeks; patients who cannot tolerate aerosol treatment; patients with perioperative myocardial infarction or malignant arrhythmia; patients with drug allergy.

2.3 Preoperative intervention measuresWe carried out the arterial blood gas analysis for patients after admission, and gave corresponding treatment according to the principle of grouping: Group A was not given aerosol treatment, group B was given aerosol inhalation normal saline treatment twice a day, group C was given budesonide aerosol treatment 1 mg twice a day, and performed blood gas analysis again after 5 d of treatment.

2.4 Intraoperative situationAll patients underwent cardiopulmonary bypass valve replacement, and anesthesia and surgery were standardized.

2.5 Postoperative intervention measuresAfter the ventilator was stopped smoothly and the tracheal intubation was removed, the corresponding aerosol treatment program was given for 5 d on the principle of grouping at the time of admission.

2.6 Observation indicatorsWe compared and analyzed the changes of blood gas results before and after the aerosol treatment of the 3 groups, and compared and analyzed the postoperative clinical symptom scores of the 3 groups.After treatment, the patient’s cough, shortness of breath, expectoration(sputum volume, sputum viscosity)and pulmonary wheezing and other clinical manifestations were scored, each item was 0-3 points, the higher the score, the more serious[6].Then, we made a comparative analysis of the clinical efficacy of the 3 groups of patients.Evaluation criteria: markedly effective: after 2-3 d of treatment, the patient’s shortness of breath improves or disappears, the cough improves, the viscosity of sputum improves, and the lung wheeze disappears; effective: after 4 d of treatment, the above clinical symptoms have been significantly improved; ineffective: after 5 d of treatment, the patient’s condition does not improve significantly or even becomes worse, or the tracheal intubation is repeated within 5 d.

Total effective rate of treatment=[(Number of markedly effective + Number of effective)/Total]×100%.

3 Results and analysis

3.1 Comparison of blood gas analysis before and after preoperative aerosol treatment in the 3 groupsThe patients were treated with aerosol before operation.After aerosol treatment, the partial pressure of oxygen and oxygenation index of the patients in group B and group C were higher than those in group A, and the difference was statistically significant; there was no significant difference in oxygen partial pressure and oxygenation index between group B and group C after aerosol treatment(Table 1).

Table 1 Comparison of blood gas analysis before and after preoperative treatment in 3 groups

3.2 Clinical symptom scores of the 3 groups of patients before and after aerosol treatmentThe clinical symptom scores of patients in group C after aerosol treatment after cardiopulmonary bypass valve replacement were significantly lower than those in groups A and B, and the difference was statistically significant(Table 2).

Table 2 Clinical symptom scores of the 3 groups before and after aerosol treatment

3.3 Clinical efficacy of the 3 groups of patientsThe total effective rate of patients in group C after aerosol treatment after cardiopulmonary bypass valve replacement was significantly higher than that of patients in group A and group B, the difference was statistically significant, and the clinical efficacy was significant(Table 3).

Table 3 Clinical efficacy of 3 groups of patients %

4 Discussion

Cardiopulmonary bypass may lead to systemic inflammatory reactions, of which the lungs are most commonly affected[7].After cardiopulmonary bypass, lung function is damaged to varying degrees, and its mechanism is complicated.During cardiopulmonary bypass, the vena cava is blocked and the lungs stop ventilating, leaving the lungs in a state of ischemia and hypoxia.Besides, the lungs are in a relatively "high temperature" state during cardiopulmonary bypass, as well as factors such as ischemia-reperfusion injury, which lead to increased pulmonary capillary permeability, decreased lung compliance, and imbalanced ventilation/blood flow ratio[8], resulting in patients suffering cough, excessive phlegm, shortness of breath, even difficulty in breathing, respiratory failure and other symptoms.The prevention and treatment of lung injury after cardiopulmonary bypass valve replacement has always been a clinical problem.By inhibiting the inflammatory response, it can effectively improve acute lung injury and promote the recovery of lung function, and improve the clinical symptoms of patients.In clinical practice, aerosol treatment of patients during the perioperative period can relieve the impaired lung function and promote their recovery.Aerosol treatment inhalation treatment can quickly reach the lungs and act on the respiratory tract.

Budesonide is the only halogen-free aerosol inhalation glucocorticoid approved by the FDA.Aerosol inhalation of budesonide is an important measure to prevent and treat pulmonary complications during the perioperative period of cardiopulmonary bypass[9-10].Budesonide can produce anti-inflammatory effects, reduce glandular secretion, reduce airway resistance, and then reduce clinical manifestations such as cough and shortness of breath.Some studies have confirmed that perioperative aerosol inhalation of budesonide can effectively inhibit the release of pro-inflammatory factors in patients undergoing cardiopulmonary bypass valve replacement, adjust the dynamic balance between pro-inflammatory factors and anti-inflammatory factors, and have certain preventive effects on perioperative lung injury[11].

In this study, aerosol inhalation of budesonide was administered before the operation to improve ventilation and optimize the lung function of patients, which has a significant clinical effect compared with the non-aerosol treatment group.After the tracheal intubation was removed after the operation, the same aerosol treatment program was administered again, which can promote the discharge of sputum, effectively improve the patients’ cough, sputum, shortness of breath and other symptoms, and accelerate the patient’s postoperative recovery.In summary, the application of budesonide aerosol inhalation during the perioperative period can effectively improve the clinical symptoms of patients after cardiopulmonary bypass valve replacement, improve the treatment effect, and improve the clinical prognosis of patients.The shortcoming of this study is we only compared and analyzed the blood gas results of the patients before the operation.In future, it is recommended to observe and analyze the changes of the patients’ lung function indicator.In addition, it is recommended to increase the study sample size, analyze the different responses of patients of different ages, different body types and comorbidities, so as to more comprehensively evaluate the impact of budesonide aerosol inhalation on the perioperative lung function of patients with cardiopulmonary bypass valve replacement, and evaluate its application value in accelerated rehabilitation surgery after cardiopulmonary bypass cardiac surgery.