格隆溴铵对老年肺癌根治术病人肺功能和肺内分流的影响

Effect of glycopyrrolate on pulmonary function and pulmonary shunt in elderly patients with lung cancer undergoing radical resection

目的观察格隆溴铵对老年肺癌根治术病人肺功能和肺内分流的影响。方法选取行肺癌根治术的老年病人90例,按照随机数表法将所有病人分为格隆溴铵组(G组)和对照组(N组),每组45例。G组病人于麻醉诱导前10 min静脉注射格隆溴铵5μg/kg,N组病人于麻醉诱导前10 min静脉注射等容量0.9%氯化钠注射液。分别于入室后(T_(0))、气管插管后双肺通气15 min(T_(1))、单肺通气(OLV)15 min(T_(2))、OLV 30 min(T_(3))、OLV 40 min(T_(4))、OLV 50 min(T_(5))6个时点连续观测病人的血流动力学,于T_(1)、T_(2)、T_(3)、T_(4)、T_(5)时刻记录气道阻力(Raw)、肺顺应性(Comp)、气道峰压(Ppeak)。采集T_(1)、T_(2)、T_(3)时刻动脉血和颈内静脉血行血气分析并记录PaO_(2)、PaCO_(2),计算肺内分流率(Qs/Qt)。结果与T_(1)时刻相比,2组病人在OLV后T_(2)、T_(3)时刻PaO_(2)均降低(P<0.05),Qs/Qt、PaCO_(2)增高(P<0.05),在T_(2)~T_(5)时刻Raw和Ppeak均明显升高(P<0.05)。G组病人在T_(3)~T_(5)时刻Comp均高于N组,Ppeak低于N组(P<0.05);T_(2)、T_(3)时刻Qs/Qt明显低于N组。结论格隆溴铵用于老年肺癌根治术病人可以明显扩张支气管,减少肺内分流,改善老年病人肺顺应性,保护肺功能且对血流动力学无明显影响。

Objective To observe the effect of glycopyrrolate on pulmonary function and pulmonary shunt in the elderly patients undergoing radical resection of lung cancer.Methods Ninety elderly patients undergoing radical resection of lung cancer were randomly divided into glycopyrrolate group(group G) and control group(group N),with 45 patients in each group.The patients in group G were intravenously injected with glycopyrrolate(5 μg/kg),while the patients in group N were intravenously injected with 0.9% sodium chloride 10 min before anesthesia induction.The hemodynamics of the patients were observed continuously at 6 time points,before anesthesia induction(T_(0)),two lung ventilation for 15 min after endotracheal intubation(T_(1)) and 15 min(T_(2)),30 min(T_(3)),40 min(T_(4)),50 min(T_(5)) after one-lung ventilation.Airway resistance(Raw),pulmonary compliance(Comp) and peak airway pressure(Ppeak) were recorded at T_(1),T_(2),T_(3),T_(4) and T_(5).Arterial blood and internal carotid venous blood were collected at T_(1),T_(2),and T_(3) for blood gas analysis.PaO_(2) and PaCO_(2) were recorded,and the intrapulmonary shunt rate (Qs/Qt) was calculated.Results After one-lung ventilation,the level of PaO_(2) decreased,and the levels of Qs/Qt,PaCO_(2) increased at T_(2) and T_(3)(P<0.05);The levels of Raw and Ppeak increased at T_(2)-T_(5)(P<0.05).Compared with group N,the level of Comp of group G was higher,and the level of Ppeak was lower at T_(3)-T_(5),and the level of Qs/Qt was lower at T_(2) and T_(3)(P<0.05).Conclusions Intravenous injection of glycopyrrolate can dilate bronchus,reduce intrapulmonary shunt,improve lung compliance,protect lung function without influencing the hemodynamics in the elderly patients undergoing radical resection of lung cancer.