盐酸戊乙奎醚对食管癌根治术呼吸循环功能的影响(1)
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【摘要】 目的 比较盐酸戊乙奎醚(长托宁)和阿托品用于食管癌根治术前药对呼吸循环功能的影响。方法 40例ASAⅠ～Ⅱ级全麻下行食管癌根治术患者,随机分为两组,P组(盐酸戊乙奎醚组)和A组(阿托品组),每组20例,每组患者术前分别静脉滴注盐酸戊乙奎醚0.02 mg/kg和阿托品0.01 mg/kg,观察双肺通气后15 min(T1)、单肺通气后60 min(T2)、再次双肺通气30 min(T3)血压、心率和动脉血气的影响。 结果T2时,两组动脉氧分压(PaO2)均显著降低(P<0.05),P组PaO2显著高于A组(P<0.05),T3时A组PaO2显著低于P组(P<0.05)。T3时P组平均动脉压(MAP)显著低于A组(P<0.05),T2和T3时A组心率显著高于P组(P<0.05)。结论 盐酸戊乙奎醚可以改善患者呼吸功能,血流动力学稳定,作用时间长,比阿托品更适合食管癌根治手术。
【关键词】 盐酸戊乙奎醚;阿托品;单肺通气;手术;呼吸循环功能
Effects of penehyclidine hydrochloride on respiratory and circulatory function in patients undergoing curative resection of esophageal carcinoma
SI Jian-luo,XING Qun-zhi,LI Yu,et al.Department of Anaesthesiology,Department of thoracic and cardiovascular surgery,The First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,China
【Abstract】 Objective To comparethe effects of penehyclidine hydrochloride and atropine on respiratory and circulatory function in patients undergoing curative resection of esophageal carcinoma.Methods Forty ASAⅠ-Ⅱpatients who suffered from esophageal carcinoma were randomly divided into two groups(group P and group A) with 20 patients in each group, group P was received with penehyclidine hydrochloride,group A was administered with atropine, mean artery pressure and heart rate were recorded, the arterial blood gas analysis was performed after 15 min double lung ventilation(T1), after 60 min one lung ventilation(T2), and after 30 min double lung ventilation once again(T3).Results PaO2 was significant lower in both groups at T2(P<0.05),PaO2 was significant higher in group P than group A at T2 and T3(P<0.05).Mean arterypressure decreased significantly in group P than group A at T3(P<0.05), heart rate was lower in group P than group A at T2 and T3 (P<0.05).Conclusion Compared with atropine, penehyclidine hydrochloride can effectively improve respiratory function, the hemodynamics is more stable and effect is longer, which is more suitable for patients undergoing curative resection of esophageal carcinoma.
【Key words】 Penehyclidine hydrochloride;Atropine;One lung vention;Operation; Respiratory and circulatory function
盐酸戊乙奎醚是新型选择性抗胆碱药物,有研究显示该药物对急性肺损伤(ALI)具有保护作用,能够改善患者的呼吸功能,从而改善严重缺氧导致的一系列脏器功能受损病理过程[1]。本研究在食管癌根治术中使用盐酸戊乙奎醚,旨在探讨其对患者呼吸和循环的影响。
1 资料与方法
1.1 一般资料 40例ASAⅠ-Ⅱ级行食管癌根治手术患者(均为左侧剖胸入路,颈部吻合),年龄42～72岁,体质量43～67 kg,男25例,女15例。随机分为盐酸戊乙奎醚组(P组)和阿托品组(A组),每组患者20例。所有受试者均签署知情同意书。两组患者术前心、肺、肝、肾功能正常,无青光眼、中枢神经系统疾病史,两组年龄、体质量、性别、手术时间差异无统计学意义(表1)。
1.2 麻醉方法 两组患者入室前30 min肌肉注射地西泮10 mg,入室后开放静脉通路,局麻下行桡动脉穿刺测量有创血压和抽动脉血测血气,中心静脉置入双腔静脉导管,安静平卧10 min后监测心率、血压,完成基础测定后,P组静脉滴注盐酸戊乙奎醚0.02 mg/kg,A组静脉滴注阿托品0.01 mg/kg。10 min后均采用双腔支气管插管,静吸复合全身麻醉。麻醉诱导:两组均用芬太尼2～4 μg/kg 、咪唑安定0.1 mg/kg、维库溴铵0.15 mg/kg、丙泊酚1 mg/kg诱导后,插入双腔支气管插管,用OLYMPUS BF-3C40型光纤支气管镜定位。术中吸入异氟醚,间断给予芬太尼、维库溴铵维持麻醉。术中补液按常规开胸手术管理。
1.3 通气方式 两组均采前Drger Fabius麻醉机控制呼吸,吸入纯氧,潮气量8～10 ml/kg,呼吸频率10～12次/min,吸呼比为1:2,开胸后即行单肺通气,潮气量8 ml/kg,呼吸频率15次/min,吸呼比为1:1.5~2,呼气末二氧化碳分压(PETCO2)4.67～6.0 KPa,气道压(Paw)<40 cm H2O,食管吻合后再次双肺通气。
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