盐酸戊乙奎醚联合低潮气量机械通气对下腹部手术老年患者肺功能的影响

目的探讨盐酸戊乙奎醚联合低潮气量机械通气对下腹部手术老年患者肺功能的影响。方法择期下腹部手术老年患者60例，按随机数字表法分为三组：常规潮气量组（A组）、盐酸戊乙奎醚联合常规潮气量组（B组）和盐酸戊乙奎醚联合低潮气量组（C组），每组20例。B、C组麻醉诱导前静脉给予盐酸戊乙奎醚0．01mg／kg，A组给予等量0．9％氯化钠。麻醉诱导后机械通气模式：A、B组：潮气量10ml／kg；C组：潮气量6ml／kg。机械通气后分别在麻醉后即刻（T1）、麻醉后1h（T2）、麻醉后2h（T3）、麻醉后8h（T4）、麻醉后24h（T5）抽血测定血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）水平；记录血气分析指标：动脉血酸碱值（pH）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2），并计算氧合指数（PaO2/FiO2）；记录术后1d肺部并发症的发生情况。结果三组患者T1时间点TNF-α、IL-6水平差异无统计学意义（P〉0．05）；C组在T2～5各时间点的TNF-α、IL-6水平均低于A、B组，差异有统计学意义（P〈0．05）。与A、B组比较，C组在T2-5各时间点PaO2和PaO2/FiO2升高，差异有统计学意义（P〈0．05）。三组患者术后1d均未发生肺部并发症。结论盐酸戊乙奎醚联合低潮气量机械通气可以改善老年患者下腹部手术中的动脉氧合、降低机械通气诱发的肺损伤，对肺功能起保护作用。

Effects of penehyclidine hydrochloride combined with low tidal volume ventilation on lung function in patients with lower abdominal operation

Objective To investigate the effect of penehyclidine hydrochloride combined with low tidal volume ventilation on lung function in patients with lower abdominal operation. Methods Sixty elderly patients who underwent elective lower abdominal operation were divided into three groups by random digits table method： the conventional tidal volume group （group A）, penehyclidine hydrochloride combined with conventional tidal volume group （group B ） and penehyclidine hydrochloride combined with low tidal volume group （group C）, 20 cases in each group. The patients in group B and group C were given penehyclidine hydrochloride 0.01 mg/kg before induction of anesthesia. The patients in group A were given equal volume of saline. After induction of anesthesia and mechanical ventilation modes ： the patients in group A and group B were given tidal volume 10 ml/kg,the patients in group C were given tidal volume 6 ml/kg. After mechanical ventilation in anesthetized （T1）, 1 h after anesthesia （T2）, 2 h after anesthesia （T3）, 8 h after anesthesia （T4）, 24 h after anesthesia （T5）, the level of tumor necrosis factor alpha （TNF- α ）, interleukin -6 （IL-6）, pH, arterial partial pressure of oxygen （PaO2） ,arterial partial pressure of carbon dioxide （PaCO2）, the calculation of oxygenation index （PaO2/FiO2） were measured and compared. The pulmonary complications after operation 1 day were recorded. Results The level of TNF-α ,IL-6 in three patients at T1 had no significant difference （P 〉 0.05 ）. The level of TNF- α , IL-6 at T2-5 in group C were significantly lower than those in group A and group B （P 〈 0.05）. Compared with group A and group B , the level of PaO2 and PaO2/FiO2 at T2-5 were increased in group C （P 〈 0.05）. None pulmonary complications were occurred in three groups. Conclusions Penehyclidine hydrochloride combined with low tidal volume ventilation may improve arterial oxygen in patients with lower abdominal operation, reduce the lung injury induced