盐酸戊乙奎醚对腹腔镜手术患者呼吸功能的影响

Effect of penehyclidine hydrochloride on respiratory function of patients undergoing laparoscopic surgery

目的观察盐酸戊乙奎醚(PHCD)在全凭静脉麻醉中对腹腔镜手术患者呼吸功能的影响。方法 50例美国麻醉医师协会(ASA)分级I~Ⅱ级,年龄25~55岁,体重指数(BMI)18~28 kg/m^2,拟在全凭静脉麻醉下行择期腹腔镜胆囊切除术的患者,随机均分为两组:盐酸戊乙奎醚组(P组)和对照组(C组)。麻醉诱导前,P组静注盐酸戊乙奎醚0.01 mg/kg、C组静注等容量生理盐水;麻醉诱导:静脉注射咪达唑仑0.05 mg/kg,舒芬太尼0.3μg/kg,靶控输注(TCI)丙泊酚,初始靶浓度(CP)设定为3.5μg/mL,顺式阿曲库铵0.15 mg/kg,肌松药起效后插入气管插管,采用容量控制模式机械通气;麻醉维持:TCI丙泊酚、舒芬太尼术中持续输注、顺式阿曲库铵术中间断推注。监测气管插管即刻(T0)、气腹建立前5 min(T1)、气腹建立即刻(T2)、气腹建成后10 min(T3)、气腹建成后30 min(T4)、关闭气腹后10 min(T5)的气道峰压(Ppeak)、平台压(Pplat)、肺顺应性(Cd)、呼吸末二氧化碳分压(PETCO2);记录对应时间点的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2);记录手术时间、麻醉时间、气腹时间、呼吸恢复时间、睁眼时间、拔管时间。结果 (1)两组患者HR、MAP、SpO2组间比较差异无统计学意义。组内比较,与T1相比,T2~T5 HR、MAP均升高(P<0.05)。(2)与C组相比,P组中T1~T5各时间点Ppeak、Pplat均降低(P<0.05),Cd均升高(P<0.05),PETCO2两组间无明显差异(P>0.05)。组内比较,与T1相比,T2~T4时的Ppeak、Pplat、PETCO2均显著高于T1(P<0.05),Cd均明显低于T1(P<0.05);与T4相比,T5时的Ppeak、Pplat均明显降低(P<0.05),Cd明显升高(P<0.05),PETCO2无明显差异(P>0.05)。结论在腹腔镜手术中,静脉注射盐酸戊乙奎醚可改善气腹引起的气道压升高和肺顺应性降低,且对患者血流动力学无明显影响,可安全有效地用于腹腔镜手术的麻醉前用药。

Objective To observe the effect of penehyclidine hydrochloride(PHCD) on respiratory function in patients undergoing laparoscopic surgery under total intravenous anesthesia.Methods Fifty patients, which were American Society of Anesthesiologists(ASA) grade Ⅰ to Ⅱ, aged 25~55 years old,body mass index(BMI) 18~28 kg/m^2, elective laparoscopic cholecystectomy underwent total intravenous anesthesia, were randomly divided into two groups, penehyclidine hydrochloride group(P group) and control group(C group). Before induction of anesthesia, group P received penicillin hydrochloride 0.01 mg/kg intravenously, and group C received intravenous saline. Anesthesia induction: intravenous midazolam 0.05 mg/kg, sufentanil 0.3 μg/kg, target-controlled infusion(TCI) propofol, initial target concentration(CP) set to 3.5 μg/mL, cis-atracurium 0.15 mg/kg, muscle relaxant was inserted into the tracheal intubation, and mechanical ventilation was performed in volume control mode;Anesthesia maintenance: TCI propofol, sufentanil continuous infusion, cis-atracurium intermediate interrupted bolus. Ppeak, Pplat, Cd, PETCO2, HR, MAP, SpO2 were monitored immediately after tracheal intubation(T0), 5 min before the establishment of pneumoperitoneum(T1), immediate establishment of pneumoperitoneum(T2), 10 min after pneumoperitoneum(T3), 30 min after pneumoperitoneum(T4) and 10 min after closed pneumoperitoneum at 10 min(T5). Operation time, anesthesia time, pneumoperitoneum time, respiratory recovery time, blink time and extubation time were recorded. Results(1)There was no significant difference in the HR, MAP and SpO2 between the two groups. Compared with T1, T2~T5 HR and MAP were increased(P<0.05).(2)Compared with group C, Ppeak and Pplat were decreased(P<0.05) and Cd were increased(P<0.05) at each time point in group P, but PETCO2 had no significant difference in the two groups(P>0.05). Compared with T1, Ppeak, Pplat and PETCO2 at T2~T4 were significantly higher than T1(P<0.05), and Cd was significantly lower than T1(P<0.05). Compared with T4, Ppeak and Pplat were significantly decreased at T5(P<0.05), Cd was significantly increased at T5(P<0.05), PETCO2 had no significant difference at T5(P>0.05). Conclusion In laparoscopic surgery, intravenous injection of penehyclime hydrochloride can improve airway pressure and lung compliance caused by pneumoperitoneum, and has no significant effect on hemodynamics. It can be safely and effectively used for laparoscopic surgery of pre-anesthesia medication.