盐酸戊乙奎醚用于妇科腹腔镜手术对自主神经平衡的影响被引量：2

Effect of penehyclidine hydrochloride on autonomic nerve balance during gynecological laparoscopic surgery

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摘要目的观察盐酸戊乙奎醚（长托宁）用于妇科腹腔镜手术中对自主神经平衡的影响。方法：选取在该院行妇科腹腔镜手术的患者90例，年龄20～55岁，体重50～70 kg。随机分为对照组Ⅰ组、Ⅱ组（静脉给予长托宁0．5 mg）、Ⅲ组（静脉给予长托宁1 mg），每组30例。患者人手术室后静脉注射生理盐水、长托宁（0．5 mg）及长托宁（1 mg），全部采用静吸复合全身麻醉，腹腔充二氧化碳气体，维持腹内压12—13 mmHg。3组患者分别于入室后5 min（佝）、静脉注射盐酸戊乙奎醚或生理盐水后（T1）、手术开始时（3＂2）、建立气腹后10 min（T3）、建立气腹30 rain（T4）、关气腹后（T5）和手术结束后（T6）几个时段，观察患者心率变异性（HRV）的各项指标。结果：3组患者心率变异高频功率（HF）、低频功率（LF）、总功率（TP）均在气管插管后明显上升，在建立气腹后Ⅱ组及Ⅲ组患者的LF及HF上升程度明显小于Ⅰ组，且Ⅲ组LF及HF上升程度小于Ⅱ组。结论：妇科腹腔镜手术术前应用长托宁对心率（HR）影响小，能明显抑制CO2气腹造成的交感神经活性升高，在维持自主神经平衡，提高全身麻醉平衡方面起到了一定作用。 Objective To observe the effect of penehyclidine hydrochloride on autonomic nerve balance during gynecological laparoscopic surgery. Methods： Ninety patients aged 20 - 55 years old （ body weight： 50 - 70 kg） undergoing gynecological laparoscopie surgery in the hospital were selected and randomly divided into I group （control group, intravenous administration of normal saline）, 11 group（ intravenous administration of penehyclidine hydroehloride 0. 5 mg） and III group （ intravenous administration of penehyclidine hydrochloride 1 mg）, 30 patients in each group; after entering into operating room, the patients were treated with different methods respectively; intravenous inhalational anesthesia was performed, carbon dioxide pneumoperitoneum was conducted, the intra - abdominal pressure was maintainedat 12 - 13 mmHg; the various indexes of heart rate variability （HRV） in the three groups were observed at 5 minutes after entering into operating room （T0）, at the time of intravenous administration （T1）, at the beginning of the surgery （T2）, at 10 minutes after establishingpneumoperitoneum （T3）, at 30 minutes after establishing pneumoperitoneum （T4）, at the time of closing pneumoperitoneum （T5） and atthe end of the surgery （T6） . Results： High-frequency power （HF）, low-frequency power （LF） and total power of HRV in the threegroups increased significantly after endotracheal intubation; the increasing amplitudes of LF and HF in II group and III group after establishing pneumoperitoneum were significantly lower than those in I group, and the increasing amplitudes of LF and HF in III group after establishing pneumoperitoneum were significantly lower than those in group. Conclusion： The effect of penehyclidine hydrochloride before gynecological laparoscopic surgery on heart rate is low, which can significantly inhibit increase of intrinsic sympathomimetic activity induced bycarbon dioxide pneumoperitoneum; penehyclidine hydroehloride plays a certain role in maintaining autonomic nerve balance and improvinggeneral anesthetic balance.