盐酸戊乙奎醚应用于小儿氯胺酮复合全凭静脉麻醉的临床研究

目的评估盐酸戊乙奎醚替代阿托品作为术前用药在小儿氯胺酮复合全凭静脉麻醉中对心血管和腺体分泌等的影响。方法40例3—10岁采用氯胺酮和丙泊酚复合全凭静脉麻醉患儿随机分为两组。麻醉前30min分别肌肉注射盐酸戊乙奎醚（P组，n=20）与阿托品（A组，n=20），观察并记录两组给药前、给药后10、20、30、60、150min时的HR、平均动脉压（MAP）、R、唾液分泌量（SS）及不良反应等指标。结果（1）P组和A组SS在给药后20、30、60min时均显著低于给药前（P〈0．01），而在150min时P组显著低于给药前及A组（P〈0．01）。（2）P组在给药后各时点的MAP、HR及R与给药前比较差异无统计学意义（P〉0．05），A组HR在给药后20、30、60min时升高（P〈0．05或〈0．01），MAP在给药后30min和60min时亦显著升高（P〈0．01），二者在同时点均高于P组（P〈0．05或〈0．01）。结论盐酸戊乙奎醚能有效地抑制呼吸道腺体分泌，持续时间较长，且对心率及血压几乎无影响，比阿托品更适合用于小儿临床麻醉前用药。

Penehyclidine hydrochloride is superior to atropine as a premedication in the ketamine intravenous anesthesia in children： a randomized controlled clinical study

Objective To evaluate the effects of penehyelidine hydrochloride as an atropine alternative on angiocarpy and glandular secretions when preraedicated in ketaraine coraplex total intravenous anesthesia（TIVA）in ehildren. Methods Forty patients aged 3-10 years undergoing ketaraine and propofol coraplex TIVA were randomly divided into two groups. Penehyclidine hydrochloride （group P,n = 20） or atropine（group A, n = 20） was preraedieated intramuscularly 30 rain before anesthesia. Heart rate（ HR ）, mean arterial pressure（MAP）,breath rate（R） and the amount of saliva secretion（SS） were recorded before preraedieation （0 min ）, 10 rain, 20 min, 30 rain,60 rain and 150 min after. Results （ 1 ）SS reduced signifieantly 20 min, 30 min and 60 min after premedieation in both groups （P 〈 0.01 ）, and in 150 min,it was still in a significantly reduced level in group P （P 〈 0.01 ）, which was significantly lower than that in group A （P 〈 0.01 ）. （2）MAP,HR and R in group P showed no significant differences before and after preraedicafion （P〉 0.05）. But in group A, HR increased significantly at 20 min,30 min and 60 min after preraedieation （P 〈 0.05 or 〈0.01）,MAP increased significantly at 30 min and 60 min after preraedieation （P〈0.01）, and meanwhile of thera were also significantly higher than those in group P （P〈 0.05 or 〈 0.01 ）. Conclusions Penehyelidine hydrechloride can effectively reduce respiratory glandular secretion with longer persistence, and nearly has no influenee on HR and blood pressure, which suggests it eould be a superior to atropine alternative as an anesthesia preraedieation in ehildren.