本文關(guān)鍵詞： 婦科 腹腔鏡 鹽酸戊乙奎醚 氣道壓 霧化吸入　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:觀察鹽酸戊乙奎醚(PCHE)靜脈注射及霧化吸入兩種不同給藥途徑對婦科腹腔鏡手術(shù)患者氣道壓的影響。方法:選取來我院實施腹腔鏡手術(shù)的婦科病人60例,將其隨機分為三組,每組20例。K組(空白對照組)在麻醉誘導(dǎo)前15分鐘給予患者靜脈滴注生理鹽水1ml;J組(靜脈滴注PCHE組)在麻醉誘導(dǎo)前15分鐘給予患者靜脈滴注PCHE1ml;W組(霧化吸入PCHE組)在麻醉誘導(dǎo)前15分鐘給予患者霧化吸入PCHE1ml。每組分別在CO2人工氣腹前(T1)時刻、氣腹后30min(T2)時刻、氣腹后60min(T3)時刻、拔管后10min(T4)時刻于麻醉機和監(jiān)護儀上記錄下氣道峰壓(Peak);氣道阻力(Raw);氣道平臺壓(Plat);呼末二氧化碳分壓(PetCO2);心率(HR);血壓(BP)。同時在T1、T2、T3、T4時刻抽取患者橈動脈血液0.5ml用于血氣分析測出氧分壓(PaO2)、二氧化碳分壓(PaCO2)、并計算出氧合指數(shù)(PaO2/FIO2)。結(jié)果:氣道壓相關(guān)指標(biāo)組間比較:在T2和T3時刻,與K組相比,J組的Plat、Peak、Raw、PetCO2值下降(P0.05)。與J組相比W組的Plat、Peak、Raw、PetCO2值顯著下降(P0.05)。組內(nèi)比較:K組、J組、W組在T2及T3時刻與T1時刻比較Peak、Plat、Raw、PetCO2均增加(P0.05)。循環(huán)指標(biāo)中組間比較:在T1、T2、T3時刻,與K組相比,J組、W組的HR、BP無差異。組內(nèi)比較:K組、J組、W組在T2及T3時刻與T1時刻相比HR、BP呈增加趨勢,但統(tǒng)計學(xué)無差異。血氣參數(shù)指標(biāo)中組間比較:在T2、T3和T4時刻,與K組相比,J組和W組的PaO2和PaO2/FIO2值增加(P0.05),且其增加幅度為W組J組K組;PaCO2值減少(P0.05),且其減少幅度為W組J組K組。組內(nèi)比較:K組和J組在T2、T3時刻與T1時刻相比PaO2及PaO2/FIO2減小,而在W組中增加。PaCO2在三組中T2、T3時刻比T1時刻增加。結(jié)論:與對照組相比鹽酸戊乙奎醚(PCHE)靜脈給藥或霧化吸入均可以對抗婦科腹腔鏡手術(shù)患者氣腹所引起地氣道壓升高,還可以降低CO2氣腹引起的PetCO2和PaCO2升高,提示PCHE能有效緩解呼吸阻力保持氣道通暢,可作為我們麻醉管理呼吸系統(tǒng)的有效途徑。而且PCHE霧化吸入給藥比PCHE靜脈滴注給藥對氣道壓的影響更大,這可以作為我們以后臨床給藥的依據(jù)。但其對HR及BP并無影響。
[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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

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本文編號：1506541