长托宁与阿托品在小儿心脏病手术基础麻醉中作用对比.docVIP

长托宁与阿托品在小儿心脏病手术基础麻醉中作用对比 　　[摘要] 目的 观察小儿心脏病手术基础麻醉中阿托品与长托宁对腺体分泌、心率的影响。方法 60例先天性心脏病患儿随机双盲分为2组，阿托品0.01mg/kg(A组)、长托宁0.02mg/kg(B组)，分别与氯胺酮联合对患儿进行基础麻醉。记录小儿诱导和术中的心率及气管插管时口腔分泌物量。结果 两试验组口腔分泌物量无差异。A组诱导后至转机前心率下降，B组心率平稳。结论 小儿心脏手术运用0.02mg/kg长托宁和氯胺酮联合进行基础麻醉，既能够有效抑制唾液腺分泌，还可以保持术中心率平稳。 　　[关键词] 长托宁； 基础麻醉； 先天性心脏病 　　[中图分类号] R541[文献标识码] B[文章编号] 1005-0515（2011）-08-001-02 　　The Different Efficacy of Penehyclidine Hydrochloride or Atropine Using in Pediatric Congenital Heart Disease Surgery 　　 　　[Abstract] Objective To evaluate efficacy of penehyclidine hydrochloride or atropine used in heart surgery foundation anesthesia．Methods 60 children who undergoing CHD surgery were randomly allocated into 2 groups．The children were medicated by intramuscularly injection with atropine 0.01 mg/kg(group A) or Penehyclidine hydrochloride 0.02 mg/kg(group B), combined with ketamine 7mg/kg when they were picked up into the operation room．The patients heart rate(HR) and secretion of salivary gland were recorded during the process of the anesthetic induction and operation．Results The salivary secretion hadnt significant difference between 2 groups．The HR in group A significantly decreased from induction to the beginning of the ECC，while the HR in group B Was stable during induction and operation．Conclusion When using ketamine as a premedication for the pediatric CHD surgery anesthesia, Penehyclidine hydrochloride at the dose of 0.02mg/kg is a good choice to inhibit the secretion of salivary gland which was increased due to using ketamine，and is efficacy of keeping the HR smoothly． 　　[Key words] Penehyclidine hydrochloride； Basic anaesthesia； Congenital heart disease 　　 　　长托宁(penehyclidine hydrochloride,盐酸戊乙奎醚)是我国自主研发的新型长效胆碱能受体阻滞药。其主要作用机理是选择性阻断中枢和外周的M1、M3、N1和N2受体，而对分布于心脏和神经突触前膜的M2受体无明显作用，因此表现出较强的腺体分泌抑制作用，同时对心率影响却较小[1]。目前大多数小儿心脏手术运用氯胺酮进行基础麻醉。为减少其因促进交感神经兴奋和腺体分泌带来的副作用，需联合使用抗胆碱能类药物。本研究的目的在于比较抗胆碱能类药物(长托宁与阿托品)与氯胺酮联合运用于小儿心脏病手术基础麻醉时对患儿腺体分泌的抑制作用及心率的影响。 　　1 对象和方法 　　1.1 患者与分组 本研究采用随机双盲对照试验。选择非紫绀型先天性心脏病患儿60例，