盐酸戊乙奎醚不同给药途径对腹腔镜手术患者呼吸力学的影响

Effect of different administration routes of penehyclidine hydrochloride on respiratory mechanics of patients undergoing gynecological laparoscopic surgery

摘要:

目的： 探讨妇科腹腔镜手术时盐酸戊乙奎醚（penehyclidine hydrochloride，PCHE）在静脉滴注与雾化吸入不同给药途径时对患者呼吸力学的影响。方法： 选取四川省人民医院行妇科腹腔镜手术的患者150例，随机分为静脉滴注组、雾化吸入组、空白对照组，每组各50例。3组患者分别在麻醉诱导前15 min给予静脉滴注PCHE 1 mL、雾化吸入PCHE 1 mL和静脉滴注生理盐水1 mL。收集人工气腹前（T₁）、气腹后30 min（T₂）、气腹后60 min（T₃）、拔管后10 min（T₄）呼吸力学指标[气道峰压、气道阻力、气道平台压、呼气末二氧化碳分压（partial pressure of end-tidal carbon dioxide，PetCO₂）]、循环力学指标[心率（heart rate，HR）、血压（blood pressure，BP）]及血气分析指标[氧分压（partial pressure of oxygen，PaO₂）、二氧化碳分压（partial pressure of carbon dioxide，PaCO₂）、氧合指数（partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen，oxygenation index，PaO₂/FiO₂）]。结果： 在T₂和T₃时刻，静脉滴注组和雾化吸入组的气道峰压、气道阻力、气道平台压值明显低于空白对照组（P<0.05），且雾化吸入组呼吸力学指标值均明显低于静脉滴注组（P<0.05）。在T₂、T₃和T₄时刻，雾化吸入组和静脉滴注组PaO₂、PaO₂/FiO₂值明显高于空白对照组（P<0.05），T₂、T₃时刻雾化吸入组PaO₂、PaO₂/FiO₂值明显高于静脉滴注组（P<0.05）；T₂、T₃和T₄时刻雾化吸入组和静脉滴注组PaCO₂值明显低于空白对照组（P<0.05），而雾化吸入组与静脉滴注组PaCO₂值差异无统计学意义（P>0.05）。3组间HR、BP值差异无统计学意义（P>0.05）。体位改变前后，3组间呼吸力学指标值、循环力学指标值及血气分析指标值差异无统计学意义（P>0.05）。结论： 妇科腹腔镜手术时人工气腹可引起呼吸道力学和血气分析指标变化，应用PCHE可有效改善患者的气道压力和呼吸内环境，为临床给药和麻醉管理提供科学依据。

Abstract:

Objective: To investigate the effects of different administration routes of intravenous drip and aerosol inhalation of penehyclidine hydrochloride (PCHE) on respiratory mechanics of patients undergoing gynecological laparoscopic surgery. Methods: A total of 150 patients undergoing gynecological laparoscopic surgery in Sichuan Provincial People's Hospital were randomized into intravenous drip group, aerosol inhalation group and blank control group, with 50 cases in each group. The three groups of patients were given intravenous drip with PCHE 1 mL, aerosolinhalation with PCHE 1 mL and intravenous drip with saline 1 mL 15 min before induction of anesthesia, respectively. Respiratory mechanics indexes (Peak, Raw, Plat, PetCO₂), circulatory mechanics indexes (HR, BP) and blood gas analysis indexes (PaO₂, PaCO₂, PaO₂/FiO₂) were collected before artificial pneumoperitoneum (T₁), 30 min after pneumoperitoneum (T₂), 60 min after pneumoperitoneum (T₃) and 10 min after extubation (T₄). Results: At T₂ and T₃, the Peak, Plat and Raw values of intravenous drip group and aerosol inhalation group were significantly lower than those of blank control group (P<0.05), and the respiratory mechanics indexes of aerosol inhalation group were significantly lower than those of intravenous drip group (P<0.05). At T₂, T₃ and T₄, the PaO₂ and PaO₂/FiO₂ values of aerosol inhalation group and intra venous drip group were significantly higher than those of blank control group (P<0.05), PaO₂ and PaO₂/FiO₂ values of aerosol inhalation group at T₂ and T₃ were significantly higher than those of intravenous drip group (P<0.05). PaCO₂ values of aerosol inhalation group and intravenous drip group at T₂, T₃ and T₄ were significantly lower than those of blank control group (P<0.05). And there was no significant difference in PaCO₂ values between intravenous drip group and aerosol inhalation group (P>0.05). There was no significant difference in HR and BP values among the three groups (P>0.05). There was no significant difference in respiratory mechanics index, circulatory mechanics index and blood gas analysis index among the three groups after the change of body position (P>0.05). Conclusion: Artificial pneumoperitoneum during gynecological laparoscopic surgery could cause changes in respiratory tract mechanics and blood gas analysis. PCHE can effectively improve the airway pressure and internal respiratory environment of patients, which provides a scientific basis for clinical administration and anesthesia management in gynecological laparoscopic surgery.