静脉注射盐酸戊乙奎醚或多索茶碱对慢性阻塞性肺疾病患者非开胸手术时呼吸力学的影响

目的 评价静脉注射盐酸戊乙奎醚或多索茶碱对慢性阻塞性肺疾病(COPD)患者非开胸手术时呼吸力学的影响.方法 择期行非开胸手术的COPD患者135例,年龄55～86岁,体重44～78 g,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将其随机分为3组(n=45):对照组(c组)、盐酸戊乙奎醚组(P组)和多索茶碱组(D组).麻醉诱导:静脉注射芬太尼4μg/kg、异丙酚1.5 mg/kg和顺阿曲库铵0.2 mg/kg,气管插管后行机械通气,维持PErCO2 40mm Hg.气管插管后5 rin时P组静脉注射盐酸戊乙奎醚0.01 mg/kg,D组静脉注射多索茶碱4 mg/kg,C组静脉注射等容量生理盐水.麻醉维持:静脉输注异丙酚5mg·kg-1·h-1和顺阿曲库铵0.2 mg·kg-1·h-1,间断静脉注射芬太尼.术中维持听觉诱发电位指数15～20.于给药前即刻、给药后30、45和60min时,记录气道峰压、气道平台压、肺顺应性和气道阻力.结果 与C组比较,给药后各时点P组和D组气道峰压、气道平台压和气道阻力均降低,肺顺应性升高(P＜0.05);P组和D组各时点呼吸力学各参数比较差异无统计学意义(P＞0.05).结论 静脉注射盐酸戊乙奎醚和多索茶碱均可改善COPD患者非开胸手术时的呼吸力学,有利于通气.

Abstract：

Objective To investigate the effects of intravenous penehyclidine hydrochloride or doxofylline on respiratory mechanics during non-thoracotomy in patients with chronic obstructive pulmonary disease (COPD).Methods One hundred and thirty-five ASA Ⅱ or Ⅲ patients with COPD, aged 55-86 yr, weighing 44-78 kg,scheduled for elective non-thoracotomy under general anesthesia, were randomly divided into 3 groups ( n = 45 each): control group (group C), penehyclidine hydrochloride group (group P) and doxofylline group (group D).Anesthesia was induced with fentanyl 4 μg/kg, propofol 1.5 rg/kg and cis-atracurium 0.2 mg/kg. The patients were tracheal intubated and mechanically ventilated. PETCO2 was maintained at 40 mm Hg. At 5 rin after tracheal intubation, penehyclidine hydrochloride 0.01 mg/kg was injected intravenously in group P, and doxofylline 4 mg/kg was injected intravenously in group D. The equal volume of normal saline was injected intravenously in group C. Anesthesia was maintained with propofol 5 mg· kg- 1 · h- 1, eis-atracurium 0.2 mg· kg- 1 · h- 1, and intermittent iv boluses of fentsnyl. The auditory evoked potential index was maintained at 15-20 during operation. The peak airway pressure, airway plateau pressure, lung compliance and airway resistance were recorded immediately before administration, and at 30, 45 and 60 rin after administration. Results Compared with group C, the peak airway pressure, airway plateau pressure and airway resistance were significantly decreased, while the lung compliance was significantly increased at each time point after administration in groups P and D ( P ＜ 0.05 ). There was no significant difference in the parameters of respiratory mechanics at each time point between group P and group D ( P ＞ 0.05). Conclusion Both intravenous penehyclidine hydrochloride and doxofylline can improve respiratory mechanics during non-thoracotomy in patients with COPD.

Effects of intravenous penehyclidine hydrochloride or doxofylline on respiratory mechanics during non-thoracotomy in patients with chronic obstructive pulmonary disease

Objective To investigate the effects of intravenous penehyclidine hydrochloride or doxofylline on respiratory mechanics during non-thoracotomy in patients with chronic obstructive pulmonary disease (COPD).Methods One hundred and thirty-five ASA Ⅱ or Ⅲ patients with COPD, aged 55-86 yr, weighing 44-78 kg,scheduled for elective non-thoracotomy under general anesthesia, were randomly divided into 3 groups ( n = 45 each): control group (group C), penehyclidine hydrochloride group (group P) and doxofylline group (group D).Anesthesia was induced with fentanyl 4 μg/kg, propofol 1.5 rg/kg and cis-atracurium 0.2 mg/kg. The patients were tracheal intubated and mechanically ventilated. PETCO2 was maintained at 40 mm Hg. At 5 rin after tracheal intubation, penehyclidine hydrochloride 0.01 mg/kg was injected intravenously in group P, and doxofylline 4 mg/kg was injected intravenously in group D. The equal volume of normal saline was injected intravenously in group C. Anesthesia was maintained with propofol 5 mg· kg- 1 · h- 1, eis-atracurium 0.2 mg· kg- 1 · h- 1, and intermittent iv boluses of fentsnyl. The auditory evoked potential index was maintained at 15-20 during operation. The peak airway pressure, airway plateau pressure, lung compliance and airway resistance were recorded immediately before administration, and at 30, 45 and 60 rin after administration. Results Compared with group C, the peak airway pressure, airway plateau pressure and airway resistance were significantly decreased, while the lung compliance was significantly increased at each time point after administration in groups P and D ( P ＜ 0.05 ). There was no significant difference in the parameters of respiratory mechanics at each time point between group P and group D ( P ＞ 0.05). Conclusion Both intravenous penehyclidine hydrochloride and doxofylline can improve respiratory mechanics during non-thoracotomy in patients with COPD.