选择性M胆碱受体拮抗剂长托宁用于神经外科手术前准备的临床观察

Clinical observation of selective cholinoceptor-M antagonist penehyclidine hydrochloride in neurosurgical preoperational medication

目的比较选择性M胆碱受体拮抗剂盐酸戊乙奎醚(长托宁)和阿托品用于神经外科手术前准备的临床效果。方法选择符合美国麻醉医师协会(ASA)Ⅰ,Ⅱ级择期施行神经外科全身麻醉手术的脑肿瘤患者60例,其中胶质瘤30例,脑膜瘤16例,神经鞘瘤14例。随机分为3组,每组各20例:对照组,手术前不予M胆碱受体拮抗剂;阿托品组于麻醉诱导前30min肌内注射阿托品0.5mg;长托宁组麻醉诱导前30min肌内注射长托宁0.5mg。3组患者间年龄、性别、体质量、手术时间及肿瘤种类等各项指标比较差异无显著性意义(P>0.05)。观察记录给予M胆碱受体拮抗剂后,3组患者在麻醉诱导前口腔干燥程度,气管插管后5min、1h、2h和手术结束拔管时呼吸道分泌物量以及心率。结果(1)给药后,阿托品组和长托宁组患者均出现口腔干燥症状。(2)麻醉诱导前及气管插管后各时段,阿托品组和长托宁组患者呼吸道内分泌物量均少于对照组,差异具有显著性意义(均P<0.05),而阿托品组与长托宁组间差异无显著性意义(P>0.05);手术结束拔管时呼吸道分泌物,阿托品组多于长托宁组,差异有显著性意义(P<0.05),但阿托品组和对照组相比,差异无显著性意义(P>0.05)。(3)给药后,阿托品组患者麻醉诱导前心率比长托宁组和对照组增快,差异均有显著性意义(P<0.05);气管插管后各时段和手术结束拔管时,3组患者心率比较差异无显著性意义(P>0.05)。结论选择性新型抗胆碱药物长托宁用于神经外科手术前用药临床效果优于阿托品。

Objective To compare the effectiveness of selective cholinoceptor-M antagonist penehyclidine hydrochloride and atropine as preoperational medication in neurosurgery. Methods A total of 60 patients, including glioma 30 cases, meningioma 16 and acoustic neuroma 14, scheduled for selective neurosurgical operation were randomly divided into three groups, 20 patients for each group, ie. control group without preoperational medication of receptor-M antagonist; atropine group and penehyclidine hydrochloride group, the patients were intramuscularly injected with 0.5 mg atropine or penehyclidine hydrochloride respectively 30 min before anesthesia induction. The difference was not significant among the three groups in comparing the parameters of age, sex, body mass, operation time and tumor classification（P〉 0.05 ）. The intensity of xerostomia after administration of receptor-M antagonist and before anesthesia induction, the volume of airway secretion and the heart rate of each patient were recorded in 5 min, 1 h, 2 h after insertion of tracheal cannula and at extubation postoperation. Results （1） After administration of drugs, the patients in both atropine group and penehyclidine hydrochloride group occurred xerostomia. （2） The volume of airway secretion in patients in atropine group and penehyclidlne hydrochloride group was significantly less than that in control group during pre-induction to post-tracheal cannula insertion in different time intervals （P〈 0.05 ）, but there was no significant difference between atropine group and penehyclidine hydrochloride group （P〉 0.05）; after operation and extubation, the volume of airway secretion in atropine group was much more than that in penehyclidine hydrochloride group （P〈0.05）, but there was no significant difference between atropine group and control group （P 〉 0.05）. （3） After administration of drug, the patients＇ heart rate in atropine group increased significantly than that in control group and penehyclidine hydrochloride group （P〈 0.05 ） but in different time intervals after tracheal cannula insertion and extubation, the patients＇ heart rates were no significant difference among the three groups （P〉 0.05）. Conclusion The administration of penehyclidine hydrochloride, a selective receptorM antagonist, as preoperational medication is more effective and better than atropine in neurosurgery.