盐酸戊乙奎醚（PCHE）不同给药途径对妇科腹腔镜手术患者气道压的影响

发布时间：2018-02-12 20:56

本文关键词： 妇科腹腔镜盐酸戊乙奎醚气道压雾化吸入　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察盐酸戊乙奎醚(PCHE)静脉注射及雾化吸入两种不同给药途径对妇科腹腔镜手术患者气道压的影响。方法:选取来我院实施腹腔镜手术的妇科病人60例,将其随机分为三组,每组20例。K组(空白对照组)在麻醉诱导前15分钟给予患者静脉滴注生理盐水1ml;J组(静脉滴注PCHE组)在麻醉诱导前15分钟给予患者静脉滴注PCHE1ml;W组(雾化吸入PCHE组)在麻醉诱导前15分钟给予患者雾化吸入PCHE1ml。每组分别在CO2人工气腹前(T1)时刻、气腹后30min(T2)时刻、气腹后60min(T3)时刻、拔管后10min(T4)时刻于麻醉机和监护仪上记录下气道峰压(Peak);气道阻力(Raw);气道平台压(Plat);呼末二氧化碳分压(PetCO2);心率(HR);血压(BP)。同时在T1、T2、T3、T4时刻抽取患者桡动脉血液0.5ml用于血气分析测出氧分压(PaO2)、二氧化碳分压(PaCO2)、并计算出氧合指数(PaO2/FIO2)。结果:气道压相关指标组间比较:在T2和T3时刻,与K组相比,J组的Plat、Peak、Raw、PetCO2值下降(P0.05)。与J组相比W组的Plat、Peak、Raw、PetCO2值显著下降(P0.05)。组内比较:K组、J组、W组在T2及T3时刻与T1时刻比较Peak、Plat、Raw、PetCO2均增加(P0.05)。循环指标中组间比较:在T1、T2、T3时刻,与K组相比,J组、W组的HR、BP无差异。组内比较:K组、J组、W组在T2及T3时刻与T1时刻相比HR、BP呈增加趋势,但统计学无差异。血气参数指标中组间比较:在T2、T3和T4时刻,与K组相比,J组和W组的PaO2和PaO2/FIO2值增加(P0.05),且其增加幅度为W组J组K组;PaCO2值减少(P0.05),且其减少幅度为W组J组K组。组内比较:K组和J组在T2、T3时刻与T1时刻相比PaO2及PaO2/FIO2减小,而在W组中增加。PaCO2在三组中T2、T3时刻比T1时刻增加。结论:与对照组相比盐酸戊乙奎醚(PCHE)静脉给药或雾化吸入均可以对抗妇科腹腔镜手术患者气腹所引起地气道压升高,还可以降低CO2气腹引起的PetCO2和PaCO2升高,提示PCHE能有效缓解呼吸阻力保持气道通畅,可作为我们麻醉管理呼吸系统的有效途径。而且PCHE雾化吸入给药比PCHE静脉滴注给药对气道压的影响更大,这可以作为我们以后临床给药的依据。但其对HR及BP并无影响。
[Abstract]:Objective: to observe the effect of intravenous injection and atomization inhalation of penehyclidine hydrochloride on airway pressure in patients undergoing laparoscopic gynecological surgery. Methods: sixty gynecological patients undergoing laparoscopic surgery in our hospital were selected. They were randomly divided into three groups. 20 cases in each group (blank control group) were given normal saline 1ml / J group (PCHE group) 15 minutes before anesthesia induction and PCHE1ml / W group (nebulized PCHE group) 15 minutes before anesthesia induction. Patients were given nebulized inhalation of PCHE1ml15 minutes before anesthesia induction. Each group was given T1 before CO2 artificial pneumoperitoneum. 30 minutes after pneumoperitoneum, 60 minutes after pneumoperitoneum and 60 minutes after pneumoperitoneum. Ten minutes after extubation, peak airway pressure was recorded on anaesthesiologist and monitor, airway resistance was Rawn, airway platform pressure was platonic, end-exhaled carbon dioxide partial pressure was PetCO _ 2, heart rate was measured, BP was determined by BPP. At the same time, 0.5 ml of radial artery blood was drawn from patients for blood gas fraction at T _ 1 T _ 2 T _ 2T _ 3T _ 4 and T _ (1) T _ (2) T _ (2) T _ (2) T _ (3) T _ (4) (n = 10 min after extubation). The oxygen partial pressure (Pao _ 2O _ 2) and CO _ 2 partial pressure (CO _ 2) were measured, and the oxygenation index (P _ 2O _ 2 / FIO _ 2) was calculated. Results: comparison of airway pressure related indexes: at T _ 2 and T _ 3, Compared with group K, the value of Platinum Peakine RawPetCO _ 2 in group J decreased P0.05, and that in group W was significantly decreased compared with group J (P 0.05). Compared with group T _ 2 and T _ 3 and T _ 1, the values of P _ (0.05) and P _ (0.05) in T _ (2) T _ (T _ 2) and T _ (2) T _ (2) T _ (2) T _ (2) T _ (2) and T _ (2) T _ (3) in T _ (1) T _ (2) T _ (2) and T _ (2) T _ (3) were increased. There was no difference in HRN BP between group J and group K, but there was no statistical difference between group J and group K at T 2 and T 3, but there was no statistical difference. The blood gas parameters were compared between groups at T 2T 3 and T 4, but there was no statistical difference between them in T 2, T 3 and T 1, but there was no statistical difference between the two groups in the blood gas parameters: at T _ 2T _ 3 and T _ 4, there was no significant difference between them. Compared with group K, the PaO2 and PaO2/FIO2 values of group J and group W were increased by P0.05G, and the increase amplitude was as follows: the value of Paco _ 2 in group J was decreased by P0.05A, and the decrease was as much as that of group K by W group. The PaO2 and PaO2/FIO2 of group J and group K were lower than those of group T _ 1 at T _ 2T _ 3 compared with that of group T _ 1 at T _ 2T _ 3. In group W, the increase of 路PaCO2 at T _ 2 T _ 3 time was higher than that at T _ 1.Conclusion: compared with the control group, intravenous administration or atomization inhalation of penehyclidine hydrochloride can antagonize the elevation of ground airway pressure induced by pneumoperitoneum in gynecological laparoscopic surgery patients. It can also reduce the increase of PetCO2 and PaCO2 induced by CO2 pneumoperitoneum, suggesting that PCHE can effectively relieve respiratory resistance and keep airway patency. It can be used as an effective way to anesthetize and manage respiratory system, and the influence of PCHE atomization inhalation on airway pressure is greater than that of PCHE intravenous drip, which can be used as the basis for clinical administration, but it has no effect on HR and BP.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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