东莨菪碱与盐酸戊乙奎醚对老年患者心率变异性及循环的影响

Influence of scopolamine or penehyclidine hydrochloride premedication on heart rate variability and circulation of elderly patients

目的研究抗胆碱能药东莨菪碱或盐酸戊乙奎醚对老年后腹腔镜手术中心率变异性(HRV)及循环的影响。方法选取后腹腔镜手术患者90例,随机分为3组,每组30例,术前给予东莨菪碱0.3 mg(S组),或盐酸戊乙奎醚1 mg(P组)或0.9%生理盐水1 mL(C组)。测定给药前、给药后30 min、气管插管后10 min、充气腹后10,30 min、放气腹后10 min的HRV。观察各时点无创血压(NIBP)、心率(HR),记录术中及术后不良事件。结果给药后30 min,东莨菪碱组HR、NIBP、LF明显升高;麻醉后,3组高频功率(HF)、低频功率(LF)明显下降。后腹膜腔气腹后,3组LF、LF/HF较气腹前明显上升;各时间点血压、心率变化差异无统计学意义;3组不良事件无明显差异。结论术前东莨菪碱或盐酸戊乙奎醚对老年全麻后腹腔镜手术自主神经系统变化影响局限,对循环干扰小,不增加不良事件。

Objective To study the effect of scopolamine or penehyclid- ine hydrochloride premedication on heart rate variability （HRV） and circulation of elderly patients during urinary surgery with retroperitoneum. Methods A total of 90 ASA Ior lI patients over 60 years were randomly assigned into 3 groups with 30 patients in each group： group P ,premedita- tion penehyclidine hydrochloride ; group S, premedication scopolamine ; group C, control group with normal saline. SBP,DBP,HR and HRV were recorded. Level of hallucinations, night terror during operation and delirium, diplopia postoperation within 3 days were evaluated. Results During the maintence of anesthesia in three groups, decreases in low frequence （LF） were noted. The power of LF and LF/HF ratio increase during retro- peritoneum inflation period in three groups. In scopolamine group the in- crease of LF, LF/HF and HR. NIBP were much more than others two groups at point of 30 rain after premedicaton. The differences were stasti- cally significant. There were no statistically significantly differences were observed in level of delirium, hallucinations, night terror and diplopia in three groups （ P 〉 0. 05）. Conclusion There were limited effects on au- tonomic functions of elderly patients premedication with usual dose of sco- polamine or penehyclidine hydrochloride. There were lower interferences on circulation. There was no increase in incidence of adverse reaction.