中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2011年
6期
723-725
,共3页
陈志远%吴健华%王玉珍%李岩%何荷蕃
陳誌遠%吳健華%王玉珍%李巖%何荷蕃
진지원%오건화%왕옥진%리암%하하번
胆碱能拮抗剂%支气管扩张药%呼吸力学%肺疾病,慢性阻塞性
膽堿能拮抗劑%支氣管擴張藥%呼吸力學%肺疾病,慢性阻塞性
담감능길항제%지기관확장약%호흡역학%폐질병,만성조새성
Cholinergic antagonists%Bronchodilator agents%Respiratory mechanics%Pulmonary disease,chronic obstructive
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.
目的 評價靜脈註射鹽痠戊乙奎醚或多索茶堿對慢性阻塞性肺疾病(COPD)患者非開胸手術時呼吸力學的影響.方法 擇期行非開胸手術的COPD患者135例,年齡55～86歲,體重44～78 g,ASA分級Ⅱ或Ⅲ級,採用隨機數字錶法,將其隨機分為3組(n=45):對照組(c組)、鹽痠戊乙奎醚組(P組)和多索茶堿組(D組).痳醉誘導:靜脈註射芬太尼4μg/kg、異丙酚1.5 mg/kg和順阿麯庫銨0.2 mg/kg,氣管插管後行機械通氣,維持PErCO2 40mm Hg.氣管插管後5 rin時P組靜脈註射鹽痠戊乙奎醚0.01 mg/kg,D組靜脈註射多索茶堿4 mg/kg,C組靜脈註射等容量生理鹽水.痳醉維持:靜脈輸註異丙酚5mg·kg-1·h-1和順阿麯庫銨0.2 mg·kg-1·h-1,間斷靜脈註射芬太尼.術中維持聽覺誘髮電位指數15～20.于給藥前即刻、給藥後30、45和60min時,記錄氣道峰壓、氣道平檯壓、肺順應性和氣道阻力.結果 與C組比較,給藥後各時點P組和D組氣道峰壓、氣道平檯壓和氣道阻力均降低,肺順應性升高(P＜0.05);P組和D組各時點呼吸力學各參數比較差異無統計學意義(P＞0.05).結論 靜脈註射鹽痠戊乙奎醚和多索茶堿均可改善COPD患者非開胸手術時的呼吸力學,有利于通氣.
목적 평개정맥주사염산무을규미혹다색다감대만성조새성폐질병(COPD)환자비개흉수술시호흡역학적영향.방법 택기행비개흉수술적COPD환자135례,년령55～86세,체중44～78 g,ASA분급Ⅱ혹Ⅲ급,채용수궤수자표법,장기수궤분위3조(n=45):대조조(c조)、염산무을규미조(P조)화다색다감조(D조).마취유도:정맥주사분태니4μg/kg、이병분1.5 mg/kg화순아곡고안0.2 mg/kg,기관삽관후행궤계통기,유지PErCO2 40mm Hg.기관삽관후5 rin시P조정맥주사염산무을규미0.01 mg/kg,D조정맥주사다색다감4 mg/kg,C조정맥주사등용량생리염수.마취유지:정맥수주이병분5mg·kg-1·h-1화순아곡고안0.2 mg·kg-1·h-1,간단정맥주사분태니.술중유지은각유발전위지수15～20.우급약전즉각、급약후30、45화60min시,기록기도봉압、기도평태압、폐순응성화기도조력.결과 여C조비교,급약후각시점P조화D조기도봉압、기도평태압화기도조력균강저,폐순응성승고(P＜0.05);P조화D조각시점호흡역학각삼수비교차이무통계학의의(P＞0.05).결론 정맥주사염산무을규미화다색다감균가개선COPD환자비개흉수술시적호흡역학,유리우통기.
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.
