摘要目的 评价盐酸戊乙奎醚预先给药对慢性阻塞性肺疾病(COPD)患者非开胸手术机械通气期间肺功能的影响.方法 择期全麻下非开胸手术的COPD患者60例,ASA分级Ⅱ或Ⅲ级,年龄58～82岁,体重45 ～ 76 kg,采用随机数字表法分为3组(n=20):Ⅰ组、Ⅱ组和Ⅲ组.于气管插管前30 min分别静脉注射生理盐水5ml(Ⅰ组)、盐酸戊乙奎醚0.01 mg/kg(Ⅱ组)和0.02 mg/kg(Ⅲ组).于机械通气30、60和120 min时记录气道峰压(Ppeak)、气道平台压(Pplat)、气道阻力(Raw)和肺顺应性(Cdyn);于机械通气120min时取动脉血样,行血气分析,计算氧合指数(OI)、呼吸指数(RI)、生理死腔率(VD/VT)及肺泡-动脉血氧分压差(A-aDO2);于机械通气前30 min及机械通气120min时取动脉血样,采用酶联免疫法测定血清TNF-α、IL8和IL-10浓度;记录气管拔管时间和术后72 h内肺部并发症发生情况.结果 与Ⅰ组比较,Ⅱ组和Ⅲ组Ppeak、Pplat、Raw、RI、VD/VT和A-aDO2降低,Cdyn、OI升高,血清TNF-α、IL-8和IL-10浓度降低,肺部并发症发生率降低(P＜0.05),气管拔管时间差异无统计学意义(P＞0.05);Ⅱ组和Ⅲ组上述指标比较差异无统计学意义(P＞0.05).结论 盐酸戊乙奎醚预先给药可减轻COPD患者非开胸手术机械通气期间炎性反应,改善肺功能,降低术后肺部并发症,有助于预后.

abstractsObjective To evaluate the effect of penehyclidine hydrochloride pretreatment on pulmonary function during mechanical ventilation in the patients with chronic obstructive pulmonary disease (COPD) undergoing non-thoracotomy.Methods Sixty patients with COPD,aged 58-82 yr,weighing 45-76 kg,of ASA physical status Ⅱ or Ⅲ,scheduled for elective non-thoracotomy under general anesthesia,were randomly divided into Ⅰ,Ⅱ and Ⅲ groups (n =20 each) using a random number table.Anesthesia was induced with iv midazolam,sufentanil,cisatracurium and propofol.The patients were endotracheally intubated and mechanically ventilated.At 30 min before endotracheal intubation,normal saline 5 ml (group Ⅰ),penehyclidine hydrochloride 0.01 mg/kg (group Ⅱ) or penehyclidine hydrochloride 0.02 mg/kg (group Ⅲ) was injected intravenously.At 30,60 and 120 min of ventilation,airway peak pressure (Ppeak),airway plateau pressure (Pplat),airway resistance (Raw) and dynamic lung compliance (Cdyn) were recorded.At 120 min of ventilation,arterial blood samples were obtained for blood gas analysis and oxygenation index (OI),respiratory index (RI),physiologic dead space fraction (VD/VT) and alveolar-arterial oxygen gradient (A-aDO2) were calculated.At 30 min before ventilation and 120 min of ventilation,blood samples were drawn from the radial artery for determination of the serum concentrations of TNF-α,IL-8 and IL-10 by ELISA.The extubation time and pulmonary complications within 72 h after operation were recorded.Results Compared with group Ⅰ,Ppeak,Pplat,Raw,RI,VD/VT and A-aDO2 were significantly decreased,Cdyn and OI were increased,the serum TNF-α,IL-8 and IL-10 concentrations and incidence of pulmonary complications were decreased,and no significant change was found in the extubation time in Ⅱ and Ⅲ groups.There were no significant differences in the parameters mentioned above between group Ⅱ and group Ⅲ.Conclusion Penehyclidine hydrochloride pretreatment can reduce the inflammatory responses during mechanical ventilation,improve pulmonary function,and decrease postoperative pulmonary complications and is helpful for prognosis in the patients with COPD undergoing non-thoracotomy.