戊乙奎醚与咪唑安定作为妇科腹腔镜手术麻醉前用药对患者血流动力学的影响

The Different Effect of Penehyclidine and Midazolam on Patients' Hemodynamics Undergoing Gynecologic Laparoscopic Surgery

目的:戊乙奎醚与咪唑安定作为妇科腹腔镜手术麻醉前用药对患者血流动力学的影响。方法:将150例美国麻醉师协会(ASA)分级Ⅰ～Ⅱ级妇科腹腔镜手术患者(病种包括子宫肌瘤、宫外孕、单纯卵巢囊肿)随机分为2组,每组75例。于麻醉诱导前10分钟分别静注戊乙奎醚0.01 mg/kg(A组)、咪唑安定0.01 mg/kg(B组)。记录并比较注药后5分钟,10分钟,20分钟患者口干程度的视觉模拟评分(visual analogue scale,VAS);记录并比较患者注药前10分钟(P1)、注药后10分钟(P2)、患者意识消失时(P3)、手术开始时(P4)、手术开始后1小时(P5)、手术结束时(P6)、苏醒后1小时(P7)时的脉搏血氧饱和度(SpO2)、心率(HR)、收缩压(SBP)、舒张压(DBP);记录并比较术后气管及口腔内分泌物量、动脉血乳酸(ABL)含量。结果:对两组患者于麻醉诱导前分别注射0.01 mg/kg戊乙奎醚和0.01 mg/kg咪唑安定,结果显示B组患者在给药后5分钟,10分钟,20分钟心率较A组相同时间点心率有显著升高(P<0.05),口干程度VAS评分B组显著高于A组。手术期间两组血液动力学变化为B组注药后血压、心率均较基础值显著降低(P<0.05);两组患者注药前后脉搏氧饱和度均无显著变化(P>0.05)。B组气管及口鼻腔分泌物的量明显多于A组,且术后测定动脉血乳酸含量B组显著高于A组(P<0.05)。结论:于麻醉诱导前20分钟静注戊乙奎醚0.01 mg/kg可以有效减少患者术中及术后口腔、呼吸道分泌物,而不致心率增加和血压升高,对患者血流动力学无显著影响;对患者微循环有明显改善作用。

Objective： To investigate the different hemodynamic change using different premedication on patients undergoing gynecologic laparoscopic surgery.Methods： 150 ASA Ⅰ-Ⅱ patients were randomly divided into 2 groups treated with different premedications,patients treated with penehyclidine named as group A while treated with midazolam as group B.VAS scores were recorded and compared at 5 min,10 min,and 20 min after patients treated with premedication.Heart rate（HR）,systolic pressure（SBP）,diastolic pressure（DBP） and oxyhemoglobin saturation（SpO2） were also recorded and compared at 5 different time points,which are patients lossing of consciousness（P1）,skin incision（P2）,1 hour after surgery began（P3）,skin suture（P4）,1 hour after patients awake.Secretion volume and arterial blood lactic acid content were recored and compared after surgery finished.Result： Both of the two groups can achieve satisfying anesthetic effect.As time went by,VSA scores increased gradually in both 2 groups.However,dramatic increase was found in group B compared with group A（P0.05）.During the surgery,the hemodynamics parameters were more stable in group A than group B.More secretion was found in group B;meanwhile,the arterial blood lactic acid content was higher in group B than group A.Conclusions： The hemodynamic parameters are much more stable using penehyclidine as premedication during gynecologic laparoscopic surgery than midazolam.Penehyclidine also can achieve better microcirculation state and decrease the airway secretions.