长托宁对二尖瓣置换术患者血液动力学及胃黏膜pH值的影响

目的:观察选择性M-受体拮抗剂长托宁对二尖瓣置换术患者血液动力学及胃粘膜pH值(i-pH)的影响。方法:选择二尖瓣置换手术30例,随机分为两组,长托宁组(C组)和东莨菪碱组(D组),分别于麻醉诱导前30min肌肉注射C组长托宁0.015mg/kg和D组东莨菪碱0.006mg/kg,记录患者在给药前(T0),给药后10min(T1),给药后30min(T2)的心率和血压的变化以及给药前(T0),给药后30min(T2),转机后10min(T3),转机后30min(T4)以及停机时(T5)对应点动脉血pH值(pHa),动脉血二氧化碳分压(PCO2),胃黏膜的pH值(i-pH)。结果:给药后与基础值相比,D组心率明显增快(P<0.05),但血压基本平稳;C组用药后心率、血压与基础值相比明显下降(P<0.05);C组用药后心率、血压明显低于D组(P<0.05);两组pHa、i-pH在T2、T3、T4、T5时明显下降(P<0.05或P<0.01),但D组比C组下降更明显(P<0.05)。结论:长托宁对二尖瓣置换术患者的血液动力学影响小于东莨菪碱,并且可以改善微循环灌注。

The effect of penehyclidine hydrochloride on hemodynamics and i-pH of patients of replacement of mitral valve

Objective: To evaluate the effect of penehyclidine hydrochloride (selective M-cholinoceptor antagonist) on hemodynamics and i-pH of patients of replacement of mitral valve. Methods: 30 cases of replacement of mitral valve were randomly divided into 2 groups. In penehyclidine hydrochloride group (group C), penehyclidine hydrochloride was injected with 0.015mg/kg 30 min before induction. In scopolamine group(group D), the dose of scopolamine was 0.006mg/kg. The changes of HR, BP were recorded before (T_0), 10 min after(T_1) and 30 min after(T_2) administration. At the same time, pHa, PCO_2 and i-pH were recorded at T_0, T_2, 10 min after (T_3), 30 min after extracorporeal circulation(T_4) and in the end of extracorporeal circulation(T_5) respectively. Results: In group D, HR increased obviously after administration (P <0.05), but BP didn't change greatly. In group C, HR and BP both decreased obviously after administration (P <0.05). HR and BP in group C were lower than those in group D (P <0.05). pHa and i-pH at T_2, T_3, T_4 and T_5 decreased in both groups and the change in group D was more obvious(P<0.05). Conclusion: The effect of penehyclidine pydrochloride on hemodynamics of patients of replacement of mitral valve was less than scopolamine and penehyclidine hydrochloride could improve perfusion of microcirculation.