静脉注射盐酸戊乙奎醚对开胸术患者肺功能的影响

目的 探讨静脉注射盐酸戊乙奎醚对开胸术患者肺功能的影响.方法 择期全麻下拟行左侧开胸食管癌根治术的患者60例,年龄30～64岁,体重50～90 kg,ASA Ⅰ或Ⅱ级,随机均分为2组(n=30),盐酸戊乙奎醚组:于开胸后20 min静脉注射盐酸戊乙奎醚0.01 mg/kg(用生理盐水稀释至2 m1),对照组:静脉注射等容量生理盐水.麻醉诱导:静脉注射芬太尼2μg/kg及罗库溴铵0.6 mg/kg,靶控输注异丙酚,血浆靶浓度4.0 μg/ml.麻醉诱导下气管插管行机械通气,持续监测肺动态顺应性,以压力-容积环(P-V环)反映肺动态顺应性,P-V环的斜率越大,肺动态顺应性越高.麻醉维持:静脉注射瑞芬太尼0.1 μg·kg-1·min-1靶控输注异丙酚,血浆靶浓度为2.0～2.5 μg/ml,并间断静脉注射罗库溴铵.术毕前5 min停用瑞芬太尼及异丙酚.分别于盐酸戊乙奎醚给药前即刻(T0)、给药后3 rain(T1)、5 min(T2)、10 min(T3)、30 min(T4)、1 h(T5)及2 h(T6)时记录肺动态顺应性及气道峰压.结果 对照组术后不同时点肺动态顺应性及气道蜂压差异均无统计学意义(P>0.05);与T0时比较,盐酸戊乙奎醚组T1-6时肺动态顺应性升高,气道峰压降低(P<0.05);与对照组比较,盐酸戊乙奎醚组T1-6时肺动态顺应性升高,气道峰压降低(P<0.05).结论 静脉注射盐酸戊乙奎醚可改善开胸术患者术中的呼吸动力学,有利于通气.

Effect of intraoperative intravenous penehyclidine hydrochloride on pulmonary function in patients undergoning thoracotomy

Objective To investigate the effect of intmopemtive intravenous penehyclidine hydrochloride on pulmonary function in patients undergoning thoracotomy.Methods Sixty ASA Ⅰ or Ⅱ patients aged 30-64 yr scheduled for elective radical esophagectomy for cancer were randomly divided into 2 group(n=30 each):penehyclidinc hydrochloride group and control group.Penehychdine hydrochloride 0.01 mg/kg(in nolmal saline 2 ml)was injected iv 20 min after opening the thoracic cavity in penehyclidine hydrochloride group.The equal vohlme of normal saline was injected iv in control group.Anesthesia was induced with fentanyl 2μg/kg,propofol 0.4μG/ml and rocuronium 0.6 mg/kg.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with remlfentanyl 0.1μg·min-1,propofol 2.0-2.5 μg/ml and intermittent iv injecfion of rocuronium.The use of remifentanyl and pmpofol was stopped 5 min before operation.Dynamic lung compliance (Cd) and peak airway pressure were monitored and recorded immediately before penehychdine hydrechlofide administration (T0) and at 3 min(T1),5 min(T2),10 min(T3),30 min(T4),1 h(T5),2 h (T6)after penehyclidine hydrochloride administration.Results There was no significant difference in Cd and peak airway pressure among different time points in control group(P>0.05).Cd was significantly higher,while peak airway pressure lower at T1-6 than at T0 in penehychdine hydrochlofide group(P<0.05).Cd wag significantly higher,while peak airway pressure lower at T1-6 in penehyclidine hydrochloride group than in control group(P<0.05) .Conclusion Intraoperative intravenous penehyclidine hydrochloride can improve the pneumodynamics and is helpful for ventilation in patients undergoing thoracotomy.