盐酸戊乙奎醚在高龄患者监测麻醉下行内镜逆行胰胆管造影术中的应用

Clinical Application of Penehyclidine Hydrochloride Used in ERCP to Monitor Anesthesia of Elderly Patients

目的观察盐酸戊乙奎醚对监测麻醉下行内镜逆行胰胆管造影术（ERCP）的高龄患者循环、呼吸功能和腺体分泌等的影响。方法收集择期行ERCP患者60例,年龄≥70岁。按美国麻醉医师协会（ASA）分级Ⅱ-Ⅲ级,随机分为3组,每组20例。麻醉诱导分别给予盐酸戊乙奎醚0.5 mg（A组）、山莨菪碱10 mg（B组）、阿托品0.5 mg（C组）联合舒芬太尼1μg/kg及丙泊酚1.5 mg/kg。待患者意识消失后,给予丙泊酚4-6 mg/（kg·h）及右美托咪定2 mg/（kg·h）泵注维持麻醉。观察并记录3组患者十二指肠穿刺成功所需时间,术中相应时点的心率、血压、脉搏血氧饱和度（Sp O2）,以及麻醉前及术后口干程度。结果 A、B组较C组能更好地抑制肠蠕动,缩短ERCP术中十二指肠乳头穿刺所需时间、提高成功率（P〈0.05）。A组在进镜前1 min（T1）、进镜即刻（T2）及进镜后1 min（T3）时点心率变化幅度小于B、C组（P〈0.05）;B组与C组相比,差异无统计学意义。3组在各时点收缩压、舒张压及SpO2差异无统计学意义。与B、C组相比,A组患者术后口干程度较轻,差异有统计学意义（P〈0.05）。结论与阿托品及山莨菪碱相比,盐酸戊乙奎醚在维持心律稳定性方面更具优势,因此更适合作为高龄患者ERCP手术的麻醉前用药。

Objective To observe the effect of penehyclidine hydrochloride used in ERCP on circulation,respiratory function and saliva secretion to monitor anesthesia of elderly patients. Methods Sixty patients with selective operation were randomly divided into the penehyclidine hydrochloride group（ A group,n = 20）,anisodamine group（ B group,n = 20） and atropine group（ C group,n = 20）. Hydrochloride 0. 5 mg（ A group）,anisodamine 10 mg（ B group） and atropine 0. 5 mg（C group） combined with sufentanil（1 μg/kg） and propofol（1. 5 mg/kg）,until patients＇ consciousness disappearing.Results Group A and B were more obvious to inhibit effect on enterokinesia（ P〈0. 05）. Group A had little impact to thirstiness. Conclusion The effect of penehyclidine hydrochloride used in ERCP is safe and effective. The penehyclidine hydrochloride has dramatic effect on stabilizing the heart rate and controlling the secreta in the respiratory tracts before premedication for elderly patients in ERCP.