Airway management process
The clinical treatment of obstructive ventilation dysfunction is mainly
designed to improve airflow and relieve smooth muscle spasms.
Aerosolized inhalation, as the preferred drug delivery method for
perioperative airway management in children, can effectively improve
abnormal lung function. In our study, we provided combined atomization
treatment with budesonide, ipratropium, and terbutaline to children with
abnormal lung function. The combination of budesonide and terbutaline
synergistically increases bronchodilatation and reduces airway
hyper-responsiveness. Terbutaline can enhance hormone receptor
sensitivity, and budesonide can promote the synthesis of β2 receptors on
the airway cell
membrane.[32]Ipratropium bromide, as a cholinergic receptor blocking drug, has a
strong effect on bronchodilatation and can effectively inhibit airway
inflammation and improve the lung ventilation ability of patients. The
combination of three aerosolized drugs can rapidly improve lung
function.[33] We
treated our patients with different atomization frequencies according to
the severity of their obstructive ventilation dysfunction. An increase
in the frequency of atomization exerts a greater superimposed effect on
bronchial dilation on the basis of the last atomization, and makes it
easier for drugs to enter the lower airway to relieve an airway
obstruction. In our study, we treated mild patients with atomization
twice a day and moderate or moderate-severe patients three times a day.
Our results showed that all the FEV1% pre improved up to 80% in these
patients, irregardless of whether the patients had mild, moderate or
moderate-severe airway obstruction. However, we needed to spend more
time improving the FEV1% pre in moderate-severe group compared with
mild group and moderate group. Studies show that the inflammatory
response of the respiratory mucosa and the neural reflex mechanism can
induce bronchial constriction that increases airway hyper-reactivity in
patients with moderate-severe OSA.[34] Therefore,
we needed to pay greater attention to such patients and employ adequate
measures to improve their lung function. We also found that small airway
dysfunction was present in 95.56% of patients with abnormal lung
function. Studies have shown that
OSA
may be an independent risk factor for small airway
diseases.[35]Although there is no gold standard for diagnosing small airway disease,
we still need attach importance to small airway dysfunction, because it
is closely associated with poor asthma control, acute exacerbation of
asthma, and the severity of airway hyper
responsiveness.[36]We found that small airway function indicators such as MEF50% pre,
MEF25% pre, and MMEF% pre, were all significantly improved after 2
days of atomization inhalation intervention.