不同剂量盐酸戊乙奎醚对腹腔镜妇科手术患者呼吸力学的影响

Effect of Different Doses of Penehyclidine Hydrochloride on Respiratory Mechanics in Patients with Laparoscopic Gynecologic Surgery

目的 观察不同剂量的盐酸戊乙奎醚（PHCD）在全身静脉麻醉中对腹腔镜妇科手术患者呼吸力学的影响.方法 120例美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级,年龄20 ～ 50岁,体重指数（BMI） 18～25kg/m2,拟在全身静脉麻醉下行择期腹腔镜妇科手术的患者,随机均分为4组,低剂量组（P1组）、中剂量组（P2组）、高剂量组（P3组）、对照组（C组）.麻醉诱导：静脉注射咪达唑仑0.03mg/kg,舒芬太尼0.3μg/kg,靶控输注（TCI）丙泊酚,顺式阿曲库铵0.15mg/kg,3min后插入SLIPA喉罩,采取容量控制机械通气;诱导完毕后分别给予盐酸戊乙奎醚P1组0.005mg/kg、P2组0.01mg/kg、P3组0.015mg/kg、C组等容量生理盐水.麻醉维持：丙泊酚TCI、舒芬太尼、顺式阿曲库铵术中持续输注.监测HR、SBP、DBP、MAP、SpO2、气道压（Peak）、肺顺应性（Cd）、呼气末二氧化碳PETCO2;术后观察不良反应情况.结果 ①4组患者与To点相比T1～T3 HR、SBP、DBP、MAP均减低,与T3相比,T4～T9 HR、SBP 、DBP、MAP均升高（P＜0.05）;②与C组相比,T3时P3组Peak明显降低、Cd明显增高（P＜0.05）.T4～T8时,P2组P3组Peak数值均低于C组同时低于P1组,Cd数值均高于C组且同时高于P1组（P＜0.05）,但P2与P3组间差异无统计学意义;③术后口干评分及复视发生率,P3组明显高于其他3组（P＜0.05）.结论 在腹腔镜妇科手术中,静脉注射盐酸戊乙奎醚0.01 mg/kg可以改善人工气腹引起的气道压升高和肺顺应性降低,术后不良反应发生率低且对患者血流动力学无明显影响.可作为推荐剂量在临床中应用.

Objective To investigate the effects of different doses of penehyclidine hydrochloride on respiratory mechanics in patients with gynecologic laparoscopic surgery in the total intravenous anesthesia.Methods A total of 120 ASA Ⅰ-Ⅱ patients aged 20-50 years,body mass index （BMI） 18-25kg/m2,undergoing elective laparoscopic gynecologic surgery in the total intravenous anesthesia,were randomly divided into four groups with 30 patients in each group：Group P1,Group P2,Group P3,Group C.Anesthesia was induced with midazolam 0.03mg/kg,sufentanil 0.3μg/kg,target-controlled infusion （TCI） of propofol,and cis-atracurium 0.15mg/kg,inserting SLIPA laryngeal mask 3 min later,taking capacity control of mechanical ventilation.After the induction,the patients in Group P1,Group P2,Group P3,Group C were respectively given penehyclidine hydrochloride 0.005mg/kg,0.01mg/kg,0.015 mg/kg and the same volume saline.Anesthesia was maintained with propofol TCI,sufentanil,cis-atracurium continuous infusion intraoperativly.HR,SBP,DBP,MAP,SpO2,Peak,Cd,PETCO2 were monitored.The postoperative adverse reaction was observed.Results ① Compared to T0 point,the HR,SBP,DBP,MAP of the four groups was reduced in the T1-T3,comparing T3 point,and the HR,SBP,DBP,MAP was raised （P 〈 0.05）.②Compared with group C,Peak of group P2 and P3 at T4-Ts was lower than group C and P1,and Cd was higher than group C and P1 （P 〈 0.05）,but the differences between P2 and P3 had no statistical significance.③The postoperative dry mouth score and incidence of diplopia of P3was higher than the other three groups（P 〈 0.05）.Conclusion During laparoscopic gynecological surgery,intravenous penehyclidine hydrochloride 0.01mg/kg can improve the airway pressure and pulmonary compliance,and the incidence of the postoperative adverse reaction was low and hemodynamics had no obvious effect on the patients.It can be used as recommended dose in the clinical application.