盐酸戊乙奎醚对控制性降压鼻内镜手术患者胃黏膜的影响  

Effect of penehyclidine hydrochloride on gastric intramucosal of patients in nasal endoscopic surgery with controlled hypotension

作　　者：金敏[1] 王春玲[1] 蔡晓岚[2] 张丽[1] 

机构地区：[1]山东大学齐鲁医院麻醉科,济南250012 [2]山东大学齐鲁医院耳鼻喉科,济南250012

出　　处：《山东大学耳鼻喉眼学报》2012年第6期54-57,共4页Journal of Otolaryngology and Ophthalmology of Shandong University

摘　　要：目的通过对控制性降压鼻内镜手术患者胃黏膜二氧化碳分压(gastric mucosa partial pressure of carbon dioxide,PgCO2)、胃黏膜pH(gastric intramucosal pH,pHi)的研究,探讨盐酸戊乙奎醚对胃黏膜的影响及其作用机制。方法择期鼻内镜手术患者60例,随机分成2组(n=30):盐酸戊乙奎醚组(A组)和空白对照组(B组),分别于麻醉诱导前30 min静脉推注0.01 mg/kg盐酸戊乙奎醚和静脉推注与A组等毫升数的注射用水,并行控制性降压维持平均动脉压(MAP)在55～60 mmHg。于降压前(T0)、降压后0.5 h(T1)、1 h(T2)、停止降压后0.5 h(T3)、1 h(T4)分别记录PgCO2,同时在上述各时间点抽取动脉血行血气分析,推算出对应点的pHi值。结果两组患者动脉血气及T0、T3、T4时点各指标组间比较差异无统计学意义(P>0.05)。与T0时点比较,两组患者在T1时点的pHi均降低(P<0.05或P<0.01),PgCO2均升高(P<0.05)。与A组比较,B组在T1、T2时点pHi降低明显(P<0.05),PgCO2升高明显(P<0.05)。结论术前静脉推注盐酸戊乙奎醚可以减少控制性降压鼻内镜手术患者pHi降低值,改善胃黏膜灌注。Objective To evaluate the influence of penehyclidine hydrochloride on gastric intramucosal of patients in nasal endoscopic surgery with controlled hypotension. Methods Sixty ASA class I or II patients scheduled for nasal endoscopic surgery under general anesthesia were randomly divided into two groups（ n = 30 each） ： the penehyclidine hydrochloride group （ group A ： penehyclidine hydrochloride was intravenous injected with 0.01 mg/kg 30 min before induction） and the control group （group B： doses of injection water equal to group A was intravenously injected at the same time point）. The mean arterial blood pressure （MAP） was maintained 55450 mmHg during controlled hypo- tension. After anesthesia induction, gastric mucosa partial pressure of carbon dioxide （ PgCO： ） was recorded before induction of controlled hypotension （ T0）, 0.5 h （ T1 ） and 1 h （ T2 ） at the height of controlled hypotension and 0.5 h （ T3 ） andl h（T4） after the termination of controlled hypotension. At the same time points, blood samples were taken for blood gas analysis, gastric intramucosal pH （pHi） was got based on Henderson-Hasselbalch standard formula. Results There was no significant difference in indexes of blood gas and TO, T3 and T4 points between the two groups（ P 〉 0.05 ）. pHi at T1 significantly decreased in both groups（ P 〈 0.05 or P 〈 0.01 ） and at T2 decreased in group B, and the changes in group A were smaller than B group （P 〈 0.05 ）. PgCO2 at T1 significantly increased in both groups （P 〈 0.05 ） and at T2 increased in group B, also the changes in group A were smaller than B group（ P 〈 0.05）. Conclusion The effect of penehyclidine pydrochloride on gastrointestinal mucosal perfusion of patients in nasal endoscopic surgery with controlled hypotension was positive, and penehyclidine pydrochloride can alleviate the degree of pHi reduction.

关 键 词：盐酸戊乙奎醚 控制性降压 鼻内镜手术 PgCO2 PHI 

分 类 号：R614.26[医药卫生—麻醉学]