Clinical Application Of Budesonide Combined With Terbutaline In The Treatment Of Thoracic Trauma Complicated With Lung Injury

Objective:To observe the changes of lung function index,inflammatory index,immune function and other clinical indicators of budesonide combined with terbutaline in patients with severe chest injury complicated with lung injury,and to explore the mechanism of reducing excessive inflammatory reaction and the clinical efficacy of improving lung function,improving immune response function and promoting rapid recovery of patients Airway management provides a safe and reliable treatment for patients with lung injury.Methods:Patients with chest trauma complicated with lung injury who were treated in the Fifth Affiliated Hospital（Zhuhai）of Zunyi Medical University from June 1,2018 to June 30,2020 were selected.According to the concise chest trauma AIS score^[1]（Annex 1）,the patients were divided into five categories:mild（1 point）,moderate（2 points）,severe non life-threatening（3 points）,severe life-threatening（4 points）,critical or survivable（5points）.Methods:58 severe patients with AIS score of 3-5 were divided into combination group（34 cases）and single drug group（24 cases）.The combination group was treated with budesonide combined with terbutaline,while the single drug group was treated with terbutaline.The lung function indexes（oxygen partial pressure,oxygen partial pressure）were measured at three time points before treatment（day 0）,day 3 and day 7,The changes of oxygenation index,inflammatory index（C-reactive protein,white blood cell count）,peripheral blood T lymphocyte subsets CD3⁺,CD4⁺,CD8⁺,CD4⁺/CD8⁺were observed.The clinical indexes such as hospitalization time,incidence of pulmonary infection,indwelling time of closed thoracic drainage tube and treatment effective rate were observed and analyzed statistically.Firstly,the normal test was carried out on the research data,and the measurement data meeting the normal distribution were adopted x±s,t test was used to compare the length of hospital stay between the two groups,and repeated measurement analysis of variance was used to compare the data at different time points,median（interquartile interval）was used for non normal distribution measurement data,and nonparametric rank sum test was used for inter group comparison;chi square test was used for two-way disordered data comparison,nonparametric rank sum test was used for unidirectional ordered data comparison,α=0.05 was the test level of inter group comparison,P<0.05 was the difference There was statistical significance.Results:All patients were cured and discharged.The results are as follows:1.Hospitalization time:according to the clinical discharge standard,for patients with severe chest injury complicated with lung injury,the hospitalization time of patients in the combination group was significantly different from that in the single drug group（P<0.05）,and the hospitalization time in the combined medication group was shorter than that in the single drug group.2.The total effective rate and incidence of pulmonary infection:the total effective rate of the combined drug group was 94.1%,and that of the single drug group was 66.6%.The total effective rate of the combined drug group was significantly higher than that of the single drug group（P<0.05）.The incidence of pulmonary infection in the combination group was significantly lower than that in the single drug group（P<0.05）.3.Chest tube indwelling time:for patients with severe chest trauma complicated with lung injury,the indwelling time of thoracic closed drainage tube in the combined medication group was significantly different from that in the single drug group（P<0.05）,and the indwelling time in the combined medication group was shorter than that in the single medication group.4.Pulmonary function:（1）oxygen partial pressure:compared with the single drug group,the oxygen partial pressure of the two groups increased gradually on the 0,3 and 7days of medication（P<0.001）,and the difference in the increase range of oxygen partial pressure between the two groups was statistically significant（P<0.05）,but there was no significant difference in the oxygen partial pressure between the two groups（P>0.05）.（2）Oxygenation index:compared with the single drug group,the oxygenation index of the two groups increased gradually on day 0,day 3 and day 7（P<0.001）,and the difference was statistically significant（P<0.05）,but there was no significant difference between the two groups（P>0.05）.5.Inflammatory parameters:（1）WBC:compared with the single drug group,the WBC of the two groups decreased gradually on the 0,3 and 7 days of the treatment（P<0.001）,but there was no significant difference between the two groups（P>0.05）.The WBC in the combination group was higher than that in the single drug group.（2）CRP:compared with the single drug group,CRP in the combination group was gradually increased on day 0 and day 3,and gradually decreased on day 3 and day 7;CRP in the single drug group gradually decreased on day 0 and day 3,and gradually increased on day 3 and day 7.The difference of CRP between the two groups was statistically significant（P<0.05）.The CRP in the combination group was higher than that in the single drug group（P<0.05）,which was most obvious on the third day of treatment.6.Immune index:（1）CD3⁺:compared with the single drug group,the CD3⁺in the combination group and the single drug group increased gradually（P<0.001）on the 0,3and 7 days after treatment,and the difference was statistically significant（P<0.05）.The CD3⁺in the combination group was higher than that in the single drug group（P<0.05）.（2）CD4⁺:compared with the monotherapy group,the CD4⁺of the two groups increased gradually on the 0,3 and 7 days after treatment（P<0.001）,and the difference of CD4⁺between the two groups was statistically significant（P<0.001）,and the difference of CD4⁺between the two groups was statistically significant（P<0.05）.（3）CD8⁺:compared with the single drug group,the CD8⁺of the two groups decreased gradually on the 0,3 and7 days of treatment（P<0.001）,and the difference of CD8⁺between the two groups was statistically significant（P<0.01）,but there was no significant difference between the two groups（P>0.05）.（4）CD4⁺/CD8⁺:compared with the single drug group,the CD4⁺/CD8⁺of the two groups increased gradually on the 0,3 and 7 days of treatment（P<0.001）,and the difference of CD4⁺/CD8⁺between the two groups was statistically significant（P<0.001）,and the difference of CD4⁺/CD8⁺between the two groups was statistically significant（P<0.05）.Conclusions:1.Budesonide combined with terbutaline aerosol inhalation can significantly improve the prognosis of patients with severe chest trauma complicated with lung injury,reduce excessive inflammatory reaction,improve lung function,improve immune function,and improve treatment efficiency.It can be used as a safe and reliable new method of airway management.2.The therapeutic effect of budesonide combined with terbutaline inhalation may be related to the improvement of peripheral blood T lymphocyte subsets CD3⁺,CD4⁺and CD4⁺/CD8⁺levels,and the enhancement of cellular immune function.