微创医学

目的探讨盐酸戊乙奎醚在老年人经皮肾镜激光碎石术(PCNL)前应用的安全性。方法选择ASA1～2级择期,年龄在60岁以上的PCNL手术病人60例,随机数字法将患者分为PCNL组(A组)和对照组(B组)各30例。A组静注盐酸戊乙奎醚0.01 mg/kg,用生理盐水稀释5 mL;B组静注东莨菪碱.01 mg/kg,用生理盐水稀释5 mL。两组分别于麻醉前(T0)、给药后1 min(T1)、给药后5 min(T2)和给药后10 min(T3)、15 min(T4)、20 min(T5)、30 min(T6)分别测量各时段的HR、SBP、DBP、MAP、CVP。结果两组T0时的各项循环指标差异无统计学意义。A组给药后各时点与给药前比较,各项循环指标均无显著变化(P>0.05)。B组在给药后的HR和RPP均较给药前明显增加(P<0.05)。与A组比较,B组相同时点的HR、RPP显著增加(P<0.05),CVP两组循环指标差异无统计学意义。结论盐酸戊乙奎醚作为老年人经皮肾镜激光碎石术前用药不影响心率,不增加耗氧,血流动力学稳定、应激反应小,明显优于东莨菪碱。

Objective To investigate the security of hydrochloride penehyclidine applied before percutaneous laser nephrolithotomy( PCNL) in the aged． Method 60 PCNL patients，aged 60 or more，ASA 1 to 2，were randomly divided into group A and group B，each with 30 cases: group A received hydrochloride penehyclidine intravenously 0． 01 mg /kg; group B received scopolamine ( dissolved in saline to 5 ml ) intravenously 0． 01 mg /kg． HR，SBP，DBP，MAP，and CVP at different time points as before anesthesia ( T0 ) ， 1 min ( T1 ) ，5 min ( T2 ) ， 10 min( T3 ) ，15 min( T4 ) ，20 min( T5 ) and 30 min( T6) after medication in two groups were measured． Results The parameters of circulation were not statistically different at T0 between two groups． Compared with before medication，parameters of circulation after medication were not showed with significant change in group A，while they were showed with significant change in group B． Compared with those of the same time point in group A，HR and RPP increased significantly，while their difference in CVP were of no statistical significance． Conclusion As premedication，hydrochloride penehyclidine does not increase the heart rate or oxygen consumption in the aged underwent PCNL，with more stable hemodynamics and less stress response than scopolamine．