Ambroxol Hydrochloride for Lung Protection in Perioperative Period: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

CHEN Yuan ^1,2 , MA Bin ¹ , YANG Kehu ¹ ,  ZHANG Peng ²

1. Evidence Based Medicine of Lanzhou University, Lanzhou 730000, China;2. Department of Cardiothoracic Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China;

Corresponding author：

ZHANG Peng, Email: zhp_tjgh@yahoo.com.cn

Keywords：

Perioperative period; Ambroxol; Lung protection; Systermatic review

DOI：

10.7507/1672-2531.20090102

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To systematically review the efficacy of ambroxol for lung protection in perioperative period.
Methods 　We followed the Cochrane Collaboration methodology to conduct systematic reviews. We searched relevant randomized controlled trials (RCTs) from The Cochrane Library, PubMed, Embase, CBM, CNKI and VIP. We assessed the methodological quality for each outcome by grading the quality, and used RevMan5.0.0 to perform meta-analysis.
Results 　Eight RCTs were eligible and included 669 patients. All of these trials used randomization but the quality scales were B. Compared to the control group, the ambroxol group had a statistically significant benefit in atelectasis, pulmonary complications, cough and expectoration degree. The RR (95%CI) were 0.44 (0.25, 0.78), 0.51 (0.34, 0.75), 0.39 (0.16, 0.94) and 0.22 (0.09, 0.53), respectively. The ambroxol group was also better than the control group in sputum volume, sputum characteristics, rales and pulmonary surfactant.
Conclusion 　Ambroxol can improve respiratory system symptoms post-operatively, reduce pulmonary complications, and prevent pulmonary surfactant from decreasing during operation. Ambroxol has a satisfactory lung protective effect in the preoperative period, but we can’t define a proper dose and usage time.

Citation： CHEN Yuan,MA Bin,YANG Kehu,ZHANG Peng. Ambroxol Hydrochloride for Lung Protection in Perioperative Period: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(5): 558-564. doi: 10.7507/1672-2531.20090102 Copy

1.	systematic review for the American College of Physicians. American College of Physicians. Ann Intern Med, 2006, 144(8): 581-595.
2.	Smetana GW, Lawrence VA, Cornell JE, et al. Preoperative pulmonary risk stratification for noncardiothoracic surgery:.
3.	Kutlu C, Williams E, Evans E, et al. Acute lung injury and acute respiratory distress syndrome after pulmonary resection. Ann Thorac Surg, 2000, 69: 376-380.
4.	Gibbs BF, Schmutzler W, Vollrath IB, et al. Ambroxol inhibits the release of histamine, leukotrienes and cytokines from human leukocytes and mast cells. Inflamm Res, 1999, 48(2): 86-93.
5.	Stetinová V, Herout V, Kvetina J. In vitro and in vivo antioxidant activity of ambroxol. Clin Exp Med, 2004, 4(3): 152-158.
6.	周海洋, 常业恬, 吕志平, 等. 盐酸氨溴索对瓣膜置换患者围术期肺损伤的保护作用. 中南大学学报医学版, 2004, 29(6): 723-724.
7.	方晓惠, 钮善福. 沐舒坦针剂治疗呼吸系统疾病疗效观察. 上海医科大学学报, 2000, 27(2): 152-153.
8.	Fegiz G. Prevent ion by Ambroxol of Bronchopulmonary Complications after Upper Abdominal Surgery: Double-Blind Italian Multicenter Clinical Study versus Placebo. Lung, 1991, 169: 69-76.
9.	Tan LJ, Liu YQ, Xu ST, et al. Role of ambroxol in protection of the decrease of PS in lung injury after thoracotomy. Journal of Shanghai Medical University, 2000, 27(6): 484-487.
10.	刘君, 崔飞, 何建行, 等. 大剂量沐舒坦在微创胸外科术后的临床应用效果. 实用医学杂志, 2006, 22(16): 1930-1931.
11.	夏宏伟, 祝沪军, 方秦模, 等. 沐舒坦在预防食管癌术后呼吸系统并发症的应用. 齐齐哈尔医学院学报, 2008, 29(5): 558-599.
12.	崔玉, 张伟峰. 食管癌患者术后应用沐舒坦的疗效观察. 医药产业资讯, 2005, 2(5): 58-60.
13.	罗文杰, 薛庆生. 沐舒坦对老年患者术后呼吸系统并发症的预防作用. 临床麻醉学杂志, 2005, 21(9): 603-604.
14.	郝孟辉, 陈志全, 王东军, 等. 沐舒坦预防胸部手术并发症的临床疗效及安全性研究. 中国综合临床, 2003, 19(9): 847-848.
15.	陈兰平, 张亚军, 施东辉, 等.盐酸氨溴索对体外循环心脏直视手术肺保护作用的临床研究. 中国心血管病研究杂志, 2005, 3(3):.
16.	Derelle J, Bertolo-Houriez E, Marchal F, et al. Respiratory evolution of patient with mucoviscidosis treated with mucolytic agents plus dornase alfa. Arch Pediatr, 1998, 5(4): 371-377.
17.	Wirtz HR. Effect of ambroxol on surfactant secretion and synthesis in isolated type II alveolar cells. Pneumologie, 2000, 54(7): 278-283.
18.	Frerking I, Günther A, Seeger W, et al. Pulmonary surfactant: functions, abnormalities and therapeutic options. Intensive Care Med, 2001, 27(11): 1699-1717.
19.	Kinugasa S, Tachibana M, Yoshimura H, et al. Postoperative pulmonary complications are associated with worse short- and longterm outcomes after extended esophagectomy. J Surg Oncol, 2004, 88(2): 71-77.
20.	Algar FJ, Alvarez A, Salvatierra A, et al. Predicting pulmonary complications after pneumonectomy for lung cancer. European Journal of Cardio-thoracic Surgery, 2003, 23: 201-208.
21.	McAlister FA, Bertsch K, Man J, et al. Incidence of and risk factors for pulmonary complications after nonthoracic surgery. Am J Respir Crit Care Med, 2005, 171: 514-517.
22.	Hwang D, Shakir N, Limann B, et al. Association of sleep-disordered breathing with postoperative complications. Chest, 2008, 133(5): 1128-1134.
23.	Smetana GW. Preoperative Pulmonary Evaluation. N Engl J Med.,1999, 340: 937-944.
24.	Laoag-Fernandez JB, Fernandez AM, Maruo T. Antenatal use of ambroxol for the prevention of infant respiratory distress syndrome. J Obstet Gynaecol Res, 2000, 26(4): 307-312.
25.	董玉清, 沈鹏, 李洋, 等. 大剂量盐酸氨溴索在普胸外科围手术期的临床效果观察. 中外健康文摘, 2007, 4(2): 106.
26.	郑艳辉, 旷寿金. 不同剂量氨溴索对哮喘豚鼠肺表面活性物质的影响. 中国医师杂志, 2003, 增刊: 5-6.
27.	-191.

1. systematic review for the American College of Physicians. American College of Physicians. Ann Intern Med, 2006, 144(8): 581-595.
2. Smetana GW, Lawrence VA, Cornell JE, et al. Preoperative pulmonary risk stratification for noncardiothoracic surgery:.
3. Kutlu C, Williams E, Evans E, et al. Acute lung injury and acute respiratory distress syndrome after pulmonary resection. Ann Thorac Surg, 2000, 69: 376-380.
4. Gibbs BF, Schmutzler W, Vollrath IB, et al. Ambroxol inhibits the release of histamine, leukotrienes and cytokines from human leukocytes and mast cells. Inflamm Res, 1999, 48(2): 86-93.
5. Stetinová V, Herout V, Kvetina J. In vitro and in vivo antioxidant activity of ambroxol. Clin Exp Med, 2004, 4(3): 152-158.
6. 周海洋, 常业恬, 吕志平, 等. 盐酸氨溴索对瓣膜置换患者围术期肺损伤的保护作用. 中南大学学报医学版, 2004, 29(6): 723-724.
7. 方晓惠, 钮善福. 沐舒坦针剂治疗呼吸系统疾病疗效观察. 上海医科大学学报, 2000, 27(2): 152-153.
8. Fegiz G. Prevent ion by Ambroxol of Bronchopulmonary Complications after Upper Abdominal Surgery: Double-Blind Italian Multicenter Clinical Study versus Placebo. Lung, 1991, 169: 69-76.
9. Tan LJ, Liu YQ, Xu ST, et al. Role of ambroxol in protection of the decrease of PS in lung injury after thoracotomy. Journal of Shanghai Medical University, 2000, 27(6): 484-487.
10. 刘君, 崔飞, 何建行, 等. 大剂量沐舒坦在微创胸外科术后的临床应用效果. 实用医学杂志, 2006, 22(16): 1930-1931.
11. 夏宏伟, 祝沪军, 方秦模, 等. 沐舒坦在预防食管癌术后呼吸系统并发症的应用. 齐齐哈尔医学院学报, 2008, 29(5): 558-599.
12. 崔玉, 张伟峰. 食管癌患者术后应用沐舒坦的疗效观察. 医药产业资讯, 2005, 2(5): 58-60.
13. 罗文杰, 薛庆生. 沐舒坦对老年患者术后呼吸系统并发症的预防作用. 临床麻醉学杂志, 2005, 21(9): 603-604.
14. 郝孟辉, 陈志全, 王东军, 等. 沐舒坦预防胸部手术并发症的临床疗效及安全性研究. 中国综合临床, 2003, 19(9): 847-848.
15. 陈兰平, 张亚军, 施东辉, 等.盐酸氨溴索对体外循环心脏直视手术肺保护作用的临床研究. 中国心血管病研究杂志, 2005, 3(3):.
16. Derelle J, Bertolo-Houriez E, Marchal F, et al. Respiratory evolution of patient with mucoviscidosis treated with mucolytic agents plus dornase alfa. Arch Pediatr, 1998, 5(4): 371-377.
17. Wirtz HR. Effect of ambroxol on surfactant secretion and synthesis in isolated type II alveolar cells. Pneumologie, 2000, 54(7): 278-283.
18. Frerking I, Günther A, Seeger W, et al. Pulmonary surfactant: functions, abnormalities and therapeutic options. Intensive Care Med, 2001, 27(11): 1699-1717.
19. Kinugasa S, Tachibana M, Yoshimura H, et al. Postoperative pulmonary complications are associated with worse short- and longterm outcomes after extended esophagectomy. J Surg Oncol, 2004, 88(2): 71-77.
20. Algar FJ, Alvarez A, Salvatierra A, et al. Predicting pulmonary complications after pneumonectomy for lung cancer. European Journal of Cardio-thoracic Surgery, 2003, 23: 201-208.
21. McAlister FA, Bertsch K, Man J, et al. Incidence of and risk factors for pulmonary complications after nonthoracic surgery. Am J Respir Crit Care Med, 2005, 171: 514-517.
22. Hwang D, Shakir N, Limann B, et al. Association of sleep-disordered breathing with postoperative complications. Chest, 2008, 133(5): 1128-1134.
23. Smetana GW. Preoperative Pulmonary Evaluation. N Engl J Med.,1999, 340: 937-944.
24. Laoag-Fernandez JB, Fernandez AM, Maruo T. Antenatal use of ambroxol for the prevention of infant respiratory distress syndrome. J Obstet Gynaecol Res, 2000, 26(4): 307-312.
25. 董玉清, 沈鹏, 李洋, 等. 大剂量盐酸氨溴索在普胸外科围手术期的临床效果观察. 中外健康文摘, 2007, 4(2): 106.
26. 郑艳辉, 旷寿金. 不同剂量氨溴索对哮喘豚鼠肺表面活性物质的影响. 中国医师杂志, 2003, 增刊: 5-6.
27. -191.

Chinese Journal of Evidence-Based Medicine

Ambroxol Hydrochloride for Lung Protection in Perioperative Period: A Systematic Review

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content