盐酸戊乙奎醚在老年患者开胸手术中的应用

The application of penehyclidine hydrochloride in elderly patients undergoing thoracotomy

目的:探讨不同剂量盐酸戊乙奎醚对老年患者开胸手术气道腺体分泌及术后谵妄的影响。方法:选择在我院行开胸食管癌根治术老年患者90例,随机分为3组,每组30例。麻醉开始前分别静注盐酸戊乙奎醚15μg/kg (P1组)、5μg/kg (P2组)和生理盐水(C组)。按照设定的时间记录患者麻醉期间循环和呼吸参数、气道腺体分泌物量、术后谵妄的情况。结果:P1组患者术后谵妄发生率为44. 83%,高于C组的14. 28%与P2组的13. 80%(P<0. 05); P1组患者气道腺体分泌物量少于C组与P2组(P<0. 05),且P2组少于C组(P<0. 05); P1组患者给予盐酸戊乙奎醚后T2时点心率低于T0时点的基础值(P<0. 05),而P2组与C组患者心率在T2时点与T0基础值差异无统计学意义(P>0. 05)。结论:盐酸戊乙奎醚5μg/kg的小剂量用药既不影响患者术后谵妄的发生率,且可获得较理想的气道腺体分泌抑制作用。

Objective: To observe the effects of different doses of penehyclidine hydrochloride on the incidence of postoperative delirium(POD) and airway secretions in elderly patients following thoracotomy.Methods: Ninety elderly patients undergoing radical thoracotomy for esophagous cancer were randomly divided into 3 group P1(penehyclidine hydrochloride was administered in dose of 15 μg/kg,30 min before anesthesia),group P2(penehyclidine hydrochloride was administered in dose of 5 μg/kg,30 min before anesthesia) and group C(treated with simple saline)( n= 30 for each group).The incidence of POD,the volume of airway secretions,respiratory and hemodynamics were maintained and observed according to prescheduled time points.Results: Patients in group P1 had higher incidence of POD than those in group C and group P2(44.83% vs. 14.28% vs. 13.80%, P< 0.05),yet lower volume of airway secretions than those in group C and group P2( P< 0.05).Airway secretion volume was lower in group P2 than in group C( P< 0.05).The HR in group P1 was lower at T 2 than at T 0( P< 0.05),yet remained insignificant at T 0 and T 2 between group P2 and group C( P > 0.05).Conclusion: Penehyclidine hydrochloride in dose of 5 μg/kg can effectively prevent the airway secretions and will not increase the incidence of POD in elderly patients undergong thoracotomy