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.