盐酸戊乙奎醚不同给药方式对大容量肺灌洗患者术后呼吸动力学的影响  

Effects of intravenous and inhalation administration of penehyclidine hydrochloride on respiratory dynamics in patients with large volume lung lavage

作　　者：夏梦[1] 赵维珊[1] 雷钧[1] 殷飞[1] 崔彦[1] 王美青[1] 江山[1] 孙杨[1] 

机构地区：[1]南京市胸科医院麻醉科,210029

出　　处：《国际麻醉学与复苏杂志》2017年第8期702-704,727,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨盐酸戊乙奎醚不同给药方式对大容量肺灌洗患者术后呼吸动力学的影响。方法择期行左全肺大容量肺灌洗术患者40例，采用完全随机分组法分成静脉注射盐酸戊乙奎醚组（A组）与雾化吸入盐酸戊乙奎醚组（B组），每组20例。灌洗开始前30minA组静脉注射盐酸戊乙奎醚0．01mg/kg，B组给予灌洗侧肺雾化吸入盐酸戊乙奎醚0．01mg／kg（用生理盐水稀释至5ml），15min。记录插管后（T0）、灌洗开始前（T1）、灌洗结束（T2）及灌洗结束后30min（T3）、60min（T4）、90min（T5）、120min（T6）灌洗侧肺气道峰压（peak airway pressure，Ppeak）及肺动态顺应性（lung dynamic compliance，Cdvn）。统计灌洗液总量、灌洗液残留量、灌洗时间，收集术中患者口腔分泌物。结果与T0比较，两组患者T1时Cdyn[A组（30．3±1．9）ml／cmH2O，B组（30．5±1．8）ml／cmH2O（1cmH2O=0．098kPa）]均明显升高，Ppeak[A组（18．8±1．2）cmH2O，B组（17．9±1．4）cmH2O）]均明显降低（P〈0．05）.T4、T5时与A组比较，B组Cdyn[（22．8±1．7）、（26．8±1．7）ml／cmH2O）]明显升高，Ppeak[（25．2±1．5）、（20．2±1．2）cmH2O）]明显降低（P〈0．05）.结论大容量肺灌洗术患者灌洗侧肺术前雾化吸入戊乙奎醚有利于患者术后Cdyn的恢复，能改善患者通气，缩短术后呼吸力学指标的恢复时间。Objective To compare therapeutic values of intravenous infusion and inhalation of penehyclidine hydrochloride in the treatment of large volume lung lavage. Methods Forty patients with large volume lung lavage were randomly divided into two groups, receiving penehyclidine hydrochloride 0.01 mg/kg through either intravenous infusion （group A） or inhalation （group B）. Respiratory dynamics was evaluated by recording peak airway pressure （Ppeak） and lung dynamic compliance （Cdyn） after intubation （T0）, before irrigation （T1）, by the end of irrigation （T2）, and 30 min （T3）, 60 min （T4）, 90 min （T5）, 120 min （T6） after the irrigation. Additional information acquired included the total amount of the lavage fluid, the residual volume of the irrigation fluid, the time of the irrigation and the collection of the oral secretions. Results Compared with the levels at To, in both groups, Cdyn was significantly increased, but Ppeak was significantly decreased. At T4, T5, compared with group A, group B showed increased Cdyn, but decreased Ppeak. Conclusions Preoperative inhalation of penehyclidine hydrochloric is beneficial to postoperative recovery in patients receiving large volume lung lavage. It can improve ventilation, and accelerate the recovery of respiratory function.

关 键 词：洗肺疗法 雾化吸入 盐酸戊乙奎醚 肺动态顺应性 

分 类 号：R614[医药卫生—麻醉学]