国际麻醉学与复苏杂志   2012, Issue (12): 3-3
    
盐酸戊乙奎醚对妇科腹腔镜手术患者术中肺通气功能的影响
于洋, 王晖, 张永谦, 岳云1()
1.北京朝阳医院麻醉科
The effect of penehyclidine hydrochloride on lung ventilation function during gynecologic laparoscopic surgery
 全文:
摘要：

目的 研究术前应用盐酸戊乙奎醚是否可以改善妇科腹腔镜患者术中肺通气功能，并观察其对循环指标的影响。 方法 选择择期腹腔镜下子宫切除或子宫肌瘤剔除术患者42例，采用信封法随机分为2组（每组21例），试验组（P组）在气管插管后10 min缓慢静注盐酸戊乙奎醚20 μg/kg，对照组（N组）静注生理盐水。记录给药前（T0）、气腹后5（T1）、30（T2）、60（T3）、90 min（T4）时患者心率(HR)、收缩压(SBP)、舒张压(DBP)、血氧饱和度(SpO2)，呼气末二氧化碳分压(PETCO2)、肺顺应性(Compl)、气道阻力(Raw)、气道峰压(Ppeak)、平台压(Pplat)与术中尿量、手术时间、输血输液量。 结果 给药前（T0）两组患者肺功能各项指标差异无统计学意义（P>0.05）；气腹后两组患者与T0时相比Ppeak、Pplat、Raw升高而Compl下降，T1、T2、T3、T4时P组患者Raw为（14.8±1.4，14.6±1.6，14.6±1.3，14.4±1.2）cm H2O•L-1•s-1（1 cm H2O=0.098 kPa），而N组分别为（16.2±1.6，16.1±1.8，16.1±1.9，16.1±1.7）cm H2O•L-1•s-1，P组皆低于N组（T1：P=0.004，T2：P=0.01，T3：P=0.005，T4， P=0.001），而Compl测量值在T3、T4两个时点P组为（30.2±3.5）ml/cm H2O，（29.9±3.6）ml/cm H2O，高于N组的（27.3±4.8）ml/cm H2O，（27.2±4.1）ml/cm H2O（T3：P=0.033，T4， P=0.031）。与T0时比较，两组患者术中HR明显下降（P=0.000），SBP、DBP、SpO2与T0比较差异无统计学意义（P>0.05）。 结论 妇科腹腔镜手术术前应用盐酸戊乙奎醚可有效改善患者气腹后肺通气功能，降低气道阻力，提高肺顺应性，对血流动力学无明显影响。
关键词： 盐酸戊乙奎醚；腹腔镜；肺功能
Abstract:

Objective To investigate the effect of preoperative penehyclidine hydrochloride on lung ventilation function during gynecologic laparoscopic surgery． Methods 42 patients scheduled for gynecologic laparoscopic surgery were randomly divided into 2 groups．Penehyclidine hydrochloride 20 μg/kg was administered in experimental group(P) and normal saline was injected in control group(N) 10 min after intubation．HR，MAP，SpO2，PetCO2 ，Raw， Ppeak，Pplat and pulmonary compliance(Compl) were monitored and recorded immediately before (T0) and at 5(T1)，30(T2)，60(T3) and 90(T4) min after injection．Results During operation，Ppeak，Pplat，Raw showed an ascend trend while Compl descended in both groups. And the value of Raw at T1、T2、T3、T4 in group P was lower than that at correspoinding time point in group N（14.8±1.4，14.6±1.6，14.6±1.3，14.4±1.2 cm H2O•L-1•s-1 vs 16.2±1.6，16.1±1.8，16.1±1.9，16.1±1.7 cm H2O•L-1•s-1) The Compl in group P was higher than that in group N（T3: 30.2±3.5 vs 27.3±4.8, P=0.033; T4: 29.9±3.6 vs 27.2±4.1 ml/cm H2O, P=0.031）．Compared to T0, SBP，DBP and SpO2 showed no difference during operation, while HR decreased significantly during operation（P=0.000） in both groups．Conclusions Application of penehyclidine hydrochloride during gynecologic laparoscopic surgery can improve the lung ventilation function，results in an increase in Compl and decrease in Raw without obvious disturbance in hemodynamics．
Key words: Penehyclidine；Laparoscopic； Lung function