长托宁在小儿先天性心脏病手术基础麻醉中的作用

The Efficacy of Penehyclidine Hydrochloride Combine with Ketamine Using in Pediatric Congenital Heart Disease Surgery

目的 观察小儿心脏病手术基础麻醉中不同剂量长托宁对腺体分泌、心率、气道压力和体温的影响。方法 150例先天性心脏病患儿随机双盲分为5组,阿托品0.01 mg/kg（Ⅰ组）、长托宁0.02 mg/kg（Ⅱ组）,0.03 mg/kg（Ⅲ组）,0.04 mg/kg（Ⅳ组）,0.05 mg/kg（Ⅴ组）分别与氯胺酮合用对患儿进行基础麻醉。记录诱导和术中心率、温度、气道峰压及气管插管时口腔分泌物量。结果 各试验组口腔分泌物无差异。Ⅰ组、Ⅱ组停机后气道峰压较体外循环前上升,Ⅲ组、Ⅳ组和Ⅴ组转机前后气道峰压无变化。Ⅰ组、Ⅱ组、Ⅲ组诱导后至转机前心率下降。Ⅴ组心率平稳。结论 小儿心脏手术氯胺酮基础麻醉时,选择0.04-0.05mg/kg长托宁作为抗胆碱能药物,能够有效抑制唾液腺分泌,保持术中心率平稳,体外循环后气道阻力不增加。

OBJECTIVE To evaluate the efficacy of penehyclidine hydrochloride combine with ketamine using in the pediatric congenital heart disease （CHD） surgery. METHODS 150 children who undergoing CHD surgery were randomly allocated into 5 groups. The children were medicated by intramuscularly injection with atropine 0.01 mg/kg（ group Ⅰ ） or penehyclidine hydrochloride 0.02 mg/kg（ group Ⅱ ） , 0.03 mg/kg（ group Ⅲ ） , 0.04 mg/kg（ group Ⅳ ） , 0.05 mg/kg（ group Ⅴ ） combined with ketamine 7mg/kg when they were picked up into the operation room. The patients＇heart rate （HR） , peak airway pressure （PAP） , body temperature （BT） and secretion of salivary gland were recorded during the process of the anesthetic induction and operation. RESULTS The salivary secretion hadn＇t significant difference between 5 groups. The PAP after extracorporeal circulation（ECC） significantly increased in group Ⅰ and Ⅱ compared with the PAP before ECC ,while there＇s no significantly difference in group Ⅲ, Ⅳ and Ⅴ. The HR in group Ⅰ , Ⅱand Ⅲ significantly decreased from induction to the beginning of the ECC, while the HR in group V was stable during induction and operation. CONCLUSION When using ketamine as a premedication for the pediatric CHD surgery anesthesia, penehyclidine hydrochloride at the dose from 0.04 to 0.05mg/kg is a good choice to inhibit the secretion of salivary gland which was increased due to using ketamine, and is efficacy of keeping the HR smoothly and preventing the increase of the PAP caused by the ECC.