长托宁复合氯胺酮用于吸毒患者的临床麻醉研究

Clinical Anaesthetic Study of Penehyclidine Hydrochloride combined with Ketamine in Drug-taken Patients under Operation

目的探讨长托宁联合氯胺酮用于吸毒患者手术的效果观察。方法 60例吸毒患者,随机分A,B两组各30例,切皮前静脉注射氯胺酮2mg/kg,A组同时注射0.01mg/kg阿托品,B组同时静脉注射0.015mg/kg长托宁。观察两组患者麻醉前后心率、血压的变化情况和评分观察呼吸道分泌物和麻醉苏醒期的精神意识恢复情况,是否出现戒断综合征。结果两组患者术前情况及手术时间和氯胺酮用药总量等一般情况无显著差别(P>0.05);两组患者注射氯胺酮后心率,血压均增高,但A组增高幅度大于B组(P<0.05);两组术中术后均无明显呼吸道分泌物,口干程度评分无明显差别;两组患者均无出现戒断综合征;A组氯胺酮所致精神方面副作用发生率和发作程度显著高于B组(P<0.05)。结论长托宁的选择性阻滞M1,M3受体,能有效减少腺体分泌物的同时并不会增加氯胺酮的交感刺激作用,但长托宁能否确切抑制中枢M1受体的作用减少氯胺酮苏醒期间精神意识副作用的发生率和发作程度和预防戒断反应的发生,仍有待进行进一步研究。

Objective To investigate the effect of penehyclidine hydrochloride combined with ketamine in drug-taken patients under operation.Methods 60 drug-taken patients were randomly devided into two groups with 30 cases each and were injected ketamine 2mg/kg before skin incision.At the same time Group A were injected atropine 0.01mg/kg while penehyclidine hydrochloride 0.015mg/kg in Group B.Observed the change of heart rate,blood pressure during anesthesia.Evaluated the secretion of respiratory tract during anesthesia and evaluated the emergence reactions during recovery of anesthesia and judged the withdrawal syndrome.Results The difference of patients’ situation before operation,operation duration and ketamine’s dosage between two groups were not significant.The patients in both groups had an augmented heart rate and blood pressure after anesthesia.But the augment of group A was more than group B.There was little secretion in patients’ respiratory tract during operation in both groups and there was no withdrawal syndrome in both groups.The emergence reactions of ketamine appeared more frequently and more severely in patients of group A than those of patients in group B.Conclusion With the characteristic of selective block muscarinic receptors（M1and M3）,penehyclidine hydrochloride didn’t augment sympathetic responses to ketamine in circulation but can depress the salvation that followed ketamine administration.Whether penehyclidine hydrochloride can definedly decrease the emergence reactions of ketamine by block the central M1 receptor and the withdrawal syndrome or not,it needs further study to confirm.