长托宁与阿托品在腹腔镜手术麻醉前用药的比较及临床观察

Clinical study of the effects of penehyclidine hydrochloride as premedication in patients undergoing laparoscopic surgery

目的比较长托宁和阿托品在腹腔镜术前用药对患者心肌耗氧量及应激反应的影响。方法选择45例美国麻醉医师协会(ASA)I^II级腹腔镜胆囊切除术患者,随机分为3组,术前30分钟分别肌注:A组阿托品0.01 mg/kg,P1组长托宁0.01 mg/kg,P2组长托宁0.02 mg/kg。记录患者给药前(T0)、诱导前(T1)、气管插管后(T2)、CO2气腹前(T3)、气腹即刻(T4)、气腹10分钟(T5)及解除气腹5分钟(T6)的收缩压、心率,计算收缩压×心率,分别抽取3组患者T0,T5,T6的静脉血,检测血管紧张素II(AII)及白细胞介素-6(IL-6)的浓度。结果1)收缩压×心率:P1组、P2组组间比较差异无显著性意义(P>0.05),但在T1~6多个时间点P1、P2组均低于A组(P<0.05或P<0.01)。2)IL-6值组间比较:在T5、T6时间点P1、P2组低于A组(P<0.01);同时P1组高于P2组(P<0.01)。3)AII值组间比较:在T5、T6时间点P1、P2组低于A组(P<0.01);P1与P2组比较差异无显著性意义(P>0.05)。结论腹腔镜患者术前使用长托宁较阿托品相比有血流动力学稳定,相对不增加心肌耗氧量及应激反应的优点。

Objective To compare the effect of penehyelidin hydroehloride（PH） and atropine using on premedieate of laparoscopie operation on patient＇ s oxygen waste of myoeardium and stress response. Methods 45 ASAⅠ - Ⅱ grade patients were randomly divided into three groups, before operation, separatel intramuscular inject atropin 0. 01mg/kg （Agroup） , PH0. 01 mg/kg（ P1 group） , 0. 02mg/kg （ P2 group）. The SBP, HR were recorded at these times ： before give drug （To ）, before anesthesia induction （ T1 ）, after insert windpipe tube （ T2 ）, before insufllation （ T3 ）, instant insufllation （T4）, 10 minutes： after insufllation （T5 ） and 10 minutes after stoping insufllation （T6 ）, AⅡ and IL-6 were measured through invenous blood at T0 ,T5 ,T6 . Results 1 ） The SBP × HR：There were no statistically significance between group Pl and P2 （ P 〉 0. 05 ）, but at many times among T1-6, the SBP × HR of group P1, P2 decreased compared with that of group A （ P 〈 0. 05 or P 〈 0. 01 ）. 2 ） Compared among groups of IL-6 ： The IL-6 at T5, T6 in group P1, P2 decreased compared with that of group A（ P 〈 0. 01 ）, and The IL-6 of group P1 is higher than that of group P2. 3 ） Compared among groups of AⅡ： The AⅡ at T5 ,T6 in group P1 ,P2 decreased compared with that of group A（ P 〈0. 01 ） ,but no statistically significance between group P1 andP2 （ P 〉 0. 05 ）. Conclusion PH can help to provide perioperafive hemodynamie stability,not increased the patient＇ s oxygen waste of myoeardium and stress response compared with atropine on premedieate use of laparoscopie operation.