盐酸戊乙奎醚对全麻老年患者潮气量和肺顺应性的影响.docx

作者单位：100044北京大学人民医院麻醉科
责任作者：潘芳
盐酸戊乙奎醚对全麻老年患者潮气量和肺顺应性的影响
张红，潘芳*，刘芳，冯艺，杨拔贤
[摘要]目的研究盐酸戊乙奎醚对全麻下老年患者的潮气量和肺顺应性的影响。方法随机选择ASAⅠ～Ⅱ级拟行气管插管全身麻醉的择期手术患者，年龄＜65岁（成年组n=20）年龄≥65岁（老年组n=20）各20例。所有患者诱导前静脉注射咪达唑仑0.03mg/kg，异丙酚、芬太尼、万可松静脉诱导；采用压力控制机械通气使呼末二氧化碳分压维持在正常范围；异丙酚、万可松持续输注维持麻醉。诱导后20min，静脉给予盐酸戊乙奎醚0.02mg/kg，监测手术开始前各时点：诱导后即刻（T0）、诱导后10min(T1)、诱导后20min给药前(T2)、给药后10min(T3)、给药后20min(T4)、给药后30min(T5)的HR、MAP、SPO2、呼末二氧化碳分压（PETCO2）、潮气量（VT）、肺胸顺应性（Comp）和给药前后的血气分析。结果与成年组比较，老年组HR、MAP差异无显著意义。老年组VT、Comp在给药前下降明显，与成年组有显著差异，给药后有明显回升。结论对于全麻老年患者，盐酸戊乙奎醚可以明显扩张支气管，改善机械通气所致的潮气量和肺顺应性下降，且对血流动力学无明显影响。
[关键词]盐酸戊乙奎醚，潮气量，肺顺应性，老年患者
Effectofpenehyclidineontidalvolumeandpulmonarycomplianceforoldpatientsduringgeneralanesthesia

ZhangHong,PanFang*,LiuFang,FengYi,etal.DepartmentofAnesthesiology,People’shospitalofPekingUniversity,Beijing100044CHINA

【Abstract】ObjectiveToinvestigatetheeffectofpenehyclidinehydrochlorideontidalvolumeandpulmonarycomplianceforoldpatientsduringgeneralanesthesia.MethodsFortyASAⅠorⅡpatientswithbodymassindex18-25kg/m2scheduledforelectiveoperationundergeneralanesthesiaweredividedinto2groupsaccordingtoage:groupⅠ(＜65yearsold)(n=20)andgroupⅡ(≥65岁)(n=20).Midazolam0.03mg/kgwasgiveni.v.aspremedicationforallthepatients.Anesthesiawasinducedwithpropofol1.5～2.5mg/kg，fentanyl3ug/kg，vecuronium0.1mg/kg.Pressurecontrolledventilation(PCV)wasperformedaftertrachealintubation,PETCO2wasmaintainedatnormalrange.Anesthesiawasmaintainedwithpropofolandvecuroniumcontinuousintravenousinfusion.Penehyclidinehydrochloride0.02mg/kgwasadministeredi.v.intwogroupsat20minafterinduction.HR、MAP、SPO2、PETCO2、tidalvolume(VT)、pulmonarycompliance（Comp）weremonitoredcontinuouslyandrecordedat0,10,20min(immediatelybeforemedication)afterinduction(T0,T1,T2)and10min,20min,30minaftermedication(T3,T4,T5).Arterialbloodgaseswereanalyzedbeforemedication(T2)and30minaftermedication(T5).ResultComparedwiththoseingroupⅠ,HRandMAPhadnosignificantdifferenceingroupⅡ.VTandCompweresignificantlydecreasedbeforemedicationandincreaseagainingroupⅡcomparedwiththosebefor