在全身热化疗术中长托宁与东莨菪碱联合应用的临床研究

The clinical research of penehyclidine hydrochloride injection combined with scopolamine in the whole body hyperthermia

目的探讨全身热化疗术中长托宁与东莨菪碱联合应用的临床可行性。方法选择30例ASAⅠ～Ⅱ级患者,分为长托宁与东莨菪碱联合应用组(A组)、长托宁组(B组)、东莨菪碱组(C组),关舱前A组和B组肌注长托宁0.02mg/kg,C组肌注东莨菪碱0.01mg/kg,术中根据出汗情况A组和C组追加东莨菪碱、B组追加长托宁,观察三组患者的食管温度升至41.8℃所需要的时间,升温前、升温至39℃、40℃、41.8℃、维持41.8℃2h的HR、MAP、CVP及术后不良反应的发生率。结果 A组和B组患者食管温度升至41.8℃所需要的时间相比无统计学差异,A、B组与C组相比的升温时间明显缩短(P<0.05);A组在40℃、41.8℃、维持41.8℃2h时的HR与B组相比均增快,但无统计学意义,C组在各温度点的HR与A组、B组相比均明显增快(P<0.05);当食管温度达到40℃以上,患者的MAP随着心率增快而下降,CVP随着心率的增快而升高,C组与A组、B组相比,MAP明显下降(P<0.05),CVP明显增高(P<0.05);B组和A组、C组相比术后的不良反应明显增加(P<0.01)。结论在全身热化疗术中长托宁与东莨菪碱联合应用能明显缩短升温时间,维持循环动力学的稳定,并减少不良反应的发生。

Objective To investigate the clinical validity of penehyclidine hydrochloride injection combined with scopolamine in the whole body hyperthermia（WBH）.Methods 30 patients,ASA Ⅰ-Ⅱ,were randomly divided into three groups： A,B and C group.The patients in A group（n=10） and B group（n=10） intramuscularly injected with penehyclidine hydrochloride（0.02mg/kg） before closing the infrared cabin.C group（n=10） intramuscularly injected with scopolamine（0.01mg/kg） at the same time.If patient had obvious sweat during WBH,additional scopolamine were injected in A and C group,and penehyclidine hydrochloride in B group.Record the time during the esophageal temperature increased to 41.8 ℃.The HR,MAP,CVP and incidence of adverse effect were recorded respectively at the time of pre-heating,heating to 39 ℃,40℃,41.8℃,and keeping body temperature at 41.8℃ for 2 hour.Results The time heating to 41.8℃ in A group had no significant different with that in the B group（P0.05）.Compared with C group,A and B group had significant shorter heating time（P0.05）.Although the HR in A group were faster than that in B group at the time of heating to 40℃,41.8℃ and keeping body temperature at 41.8℃ for 2 hour,there were no significant difference.The HR in C group at each time were all faster than HR in A and B groups（P0.05）.After the esophageal temperature increased to 40 ℃,the MAP decreased along with the HR increase,and the CVP increased.Compared with A and B group,the MAP in C group were significantly decreased,and the CVP were increased.The incidence of adverse effects in B group were significantly increased（P0.01）.Conclusion Penehyclidine hydrochloride injection combined with scopolamine in WBH can significantly decrease the heating time,keep haemodynamics stability and decrease the incidence of adverse reaction.