盐酸戊乙奎醚与东莨菪碱在小儿氯胺酮麻醉前用药的临床观察

Clinical observation of penehyclidine and scopolamine in pediafric ketamine preanesthetic medication

目的对比研究小儿氯胺酮麻醉前应用盐酸戊乙奎醚与东莨菪碱的临床效果。方法手术患儿50例,随机分为东莨菪碱组和盐酸戊乙奎醚组,每组25例。两组均于术前30 min分别肌注盐酸戊乙奎醚(0.01 mg/kg)和东莨菪碱(0.01mg/kg)。静脉给予氯胺酮(1 mg/kg)常规复合臂丛神经阻滞(利布合剂0.5 ml/kg),记录给药前15 min、给药后15 min、20 min、30 min,给氯胺酮15 min后血压、心率、SPO2、呼吸道唾液分泌物、面色、皮肤、口干等情况。结果东莨菪碱组术前及用药后心率、血压均比盐酸戊乙奎醚组升高(P<0.05)。氯胺酮麻醉后,东莨菪碱组心率、血压与盐酸戊乙奎醚组比较差异无统计学意义(P>0.05)。SPO2两组时点值无显著差别,东莨菪碱组呼吸道分泌物明显多于盐酸戊乙奎醚组。结论盐酸戊乙奎醚对M受体有较高的选择性,而且不致血压升高和心率增快,并具备与东莨菪碱类似的抗胆碱作用,术中呼吸道分泌物明显减少,是小儿术前用药中较为理想的抗胆碱药物。

Objective To study the clinical effect of penehyclidine in pediatric ketamine preanesthetic medication in comparion with scopolamine. Methods Fifty children aged 4- 7 years undergoing general anesthesia of ketamine （KT）, were randomly assigned to group A （scopolamine, SCOP） and group B （penehyclidine hydrochloride, PHC）, 25 each. 30 min preoperation, PHC（0.01 mg/kg） was administered i. m. to groupA and SCOP（0.01 mg/kg）i, m. to group B. Conventional composite lidocaine/bupivacaine brachial plexus block and KT （1 mg/kg iv）. anesthesia were performed. Discontinuous supplementary KT （0.5 - 1 mg/kg） was given for the maintenance of anesthesia. In the course of surgery, spontaneous breathing was maintained, Patients various moniforing items were recordeal 15 min, pre - mediontion, and 15,20, and 30 rain, post 15 min modiention, and after KT administration. Results Emotional stability was seenin both groups. No significant differencep in SPO2 between the two groups. Higher BP and HR in Group B than in Group A （ P 〈 0.05） preoperation and postmedication. No significant differences in BP and HR between the two groups after KT anesthesia （ P 〉 0.05） .More salivary secretion from respiratory tract in group A than in group B. Conclusions PHC is an ideal anficholinergic drug in pediatric - KT preanesthefic medication with higher selectivity to M receptor, similar to SCOP, without increasing BP and HR, while fignificantly reducing salivary secretion from respiratory tract.