2018 年第 7 期 第 13 卷

盐酸戊乙奎醚对肺癌根治术患者肺内分流和氧合功能及肺换气功能的影响

Effect of penehyclidine hydrochloride on pulmonary shunt, arterial oxygenation and pulmonary ventilation in patients undergoing radical resection of lung cancer

作者：房芳周俊辉刘晓乐孟睿奚高原孟宪慧

英文作者：

单位：450008郑州，河南省胸科医院麻醉科

英文单位：

关键词：肺癌根治术；盐酸戊乙奎醚；单肺通气；肺内分流；动脉氧合；肺换气功能

英文关键词：

• 摘要：

• 【摘要】目的    探讨盐酸戊乙奎醚对肺癌根治术患者围术期肺内分流和氧合功能及肺换气功能的影响。方法    选取2017年3—11月于河南省胸科医院择期接受肺癌根治术的患者60例，按照随机数字表法将所有患者分为盐酸戊乙奎醚组(PHC组)和对照组，每组30例。PHC组患者于麻醉诱导前10 min静脉注射盐酸戊乙奎醚0.01 mg/kg；对照组患者于麻醉诱导前10 min静脉注射等容量0.9%氯化钠注射液。分别于麻醉诱导前(T0)、单肺通气前(T1)、单肺通气10 min(T2)、30 min(T3)、60 min(T4)、120 min(T5)、单肺通气结束后10 min(T6)和手术结束时(T7)连续观测患者的血流动力学和动脉血气等指标，计算肺内分流量(QS/QT)、肺泡-动脉血氧分压差［P(A-a)DO2］及呼吸指数。记录单肺通气时间及手术时间。观察患者麻醉恢复期精神异常的发生情况。结果    2组间单肺通气时间、手术时间、平均动脉压、心率、脉搏血氧饱和度及气道压力比较，差异均无统计学意义(均P＞0.05)。PHC组T2～T5时动脉血氧分压明显高于对照组，QS/QT、P(A-a)DO2、呼吸指数明显低于对照组［QS/QT：（31.4±1.8）%比（37.8±2.7）%、（26.5±2.8）%比（33.5±3.1）%、（22.9±1.9）%比（30.2±2.7）%、（18.9±2.6）%比（27.7±3.1）%，P(A-a)DO2：（433±40）mmHg（1 mmHg=0.133 kPa）比（484±35）mmHg、（423±42）mmHg比（467±36）mmHg、（386±42）mmHg比（443±37）mmHg、（332±40）mmHg比（405±37）mmHg，呼吸指数：（1.82±0.26）比（2.59±0.32）、（1.71±0.34）比（2.29±0.31）、（1.35±0.25）比（1.96±0.26）、（0.98±0.22）比（1.53±0.29）］，差异均有统计学意义(均P＜0.05)。2组患者均无精神异常症状发生。结论    盐酸戊乙奎醚用于肺癌根治术围术期患者，能有效减少肺内分流，改善动脉氧合及肺换气功能，从而对此类手术患者产生一定的肺保护作用。

• 【Abstract】Objective    To investigate the effect of penehyclidine hydrochloride on pulmonary shunt, arterial oxygenation and pulmonary ventilation in patients undergoing radical surgery of lung cancer. Methods    A total of 60 patients undergoing radical resection of lung cancer from March to November 2017 in Henan Provincial Chest Hospital were randomly divided into penehyclidine hydrochloride group(PHC group) and control group, with 30 patients in each group. The PHC group was intravenously injected penehyclidine hydrochloride 0.01 mg/kg and the control group was injected 0.9% sodium chloride solution at 10 min before anesthesia induction. Hemodynamic indexes, blood gas indexes, intrapulmonary flow(QS/QT), alveolar-arterial oxygen partial pressure difference［P(A-a)DO2］ and respiratory index were recorded before anesthesia induction(T0), before one-lung ventilation(T1), 10 min(T2), 30 min(T3), 60 min(T4), 120 min(T5) after one-lung ventilation, 10 min after the end of one-lung ventilation(T6) and at the end of operation(T7). One-lung ventilation time, operation time and occurrence of mental abnormality during anesthesia recovery period were recorded. Results    There were no significant differences of one-lung ventilation time, operation time, mean arterial pressure, heart rate, pulse oxygen saturation and airway pressure between groups(P＞0.05). During T2-T5, arterial oxygen partial pressure in PHC group was significantly higher than that in control group; QS/QT, P(A-a)DO2 and respiratory index in PHC group were significantly lower than those in control group［QS/QT： （31.4±1.8）% vs （37.8±2.7）%, （26.5±2.8）% vs （33.5±3.1）%, （22.9±1.9）% vs （30.2±2.7）%, （18.9±2.6）% vs （27.7±3.1）%； P(A-a)DO2： （433±40）mmHg vs （484±35）mmHg, （423±42）mmHg vs （467±36）mmHg, （386±42）mmHg vs （443±37）mmHg, （332±40）mmHg vs （405±37）mmHg； respiratory index： （1.82±0.26） vs （2.59±0.32）, （1.71±0.34） vs （2.29±0.31）, （1.35±0.25） vs （1.96±0.26）, （0.98±0.22） vs （1.53±0.29）］(P＜0.05). No abnormal mental symptom was observed. Conclusion    Intravenous administration of penehyclidine hydrochloride can effectively decrease intrapulmonary shunt, improve arterial oxygenation and pulmonary ventilation function in patients with radical resection of lung cancer.

  【Key words】Radical resection of lung cancer;Penehyclidine hydrochloride;One-lung ventilation;Pulmonary shunt;Arterial oxygenation;Pulmonary ventilation

  【Fund program】Medical Science and Technology Project of Henan Province(201602299)