格隆溴铵对老年肺癌根治术病人肺功能和肺内分流的影响

doi:10.3969/j.issn.1003-9198.2023.07.005

摘要/Abstract

摘要： 目的观察格隆溴铵对老年肺癌根治术病人肺功能和肺内分流的影响。方法选取行肺癌根治术的老年病人90 例，按照随机数表法将所有病人分为格隆溴铵组(G 组)和对照组(N 组)，每组45 例。G 组病人于麻醉诱导前10 min 静脉注射格隆溴铵5 μg/ kg，N 组病人于麻醉诱导前10 min 静脉注射等容量0.9％氯化钠注射液。分别于入室后(TO)、气管插管后双肺通气15 min(T₁)、单肺通气(OLV)15 min(T₂)、OLV 30 min(T₃)、OLV40 min(T₄)、OLV 50 min(T₅)6 个时点连续观测病人的血流动力学，于T₁、T₂、T₃、T₄、T₅时刻记录气道阻力(Raw)、肺顺应性(Comp)、气道峰压(Ppeak)。采集T₁、T₂、T₃时刻动脉血和颈内静脉血行血气分析并记录PaO₂、PaCo₂，计算肺内分流率(Qs/Qt)。结果与T₁ 时刻相比，2 组病人在OLV 后T₂、T₃时刻PaO₂ 均降低(P<0.05)，Qs/Qt、PaCo ₂增高(P<0.05)，在T₂～T₅时刻Raw 和Ppeak均明显升高(P<0.05)。G 组病人在T₃～T₅ 时刻Comp均高于N组，Ppeak低于N组(P<0.05)；T₂、T₃时刻Qs/Qt 明显低于N 组。结论格隆溴铵用于老年肺癌根治术病人可以明显扩张支气管，减少肺内分流，改善老年病人肺顺应性，保护肺功能且对血流动力学无明显影响。

关键词: 格隆溴铵, 肺功能, 肺内分流, 老年人

Abstract: Objective To observe the effect of glycopyrrolate on pulmonary function and pulmonary shunt in the elderly patients undergoing radical resection of lung cancer. Methods Ninety elderly patients undergoing radical resection of lung cancer were randomly divided into glycopyrrolate group (group G) and control group (group N), with 45 patients in each group. The patients in group G were intravenously injected with glycopyrrolate (5 μg/kg), while the patients in group N were intravenously injected with 0.9% sodium chloride 10 min before anesthesia induction. The hemodynamics of the patients were observed continuously at 6 time points, before anesthesia induction (T₀), two lung ventilation for 15 min after endotracheal intubation (T₁) and 15 min (T₂), 30 min (T₃), 40 min (T₄), 50 min (T₅) after one-lung ventilation. Airway resistance (Raw), pulmonary compliance (Comp) and peak airway pressure (Ppeak) were recorded at T₁, T₂, T₃, T₄ and T₅. Arterial blood and internal carotid venous blood were collected at T₁, T₂, and T₃ for blood gas analysis. PaO₂ and PaCO₂ were recorded, and the intrapulmonary shunt rate (Qs/Qt) was calculated. Results After one-lung ventilation, the level of PaO₂ decreased, and the levels of Qs/Qt, PaCO₂ increased at T₂ and T₃ (P＜0.05); The levels of Raw and Ppeak increased at T₂-T₅ (P＜0.05). Compared with group N, the level of Comp of group G was higher, and the level of Ppeak was lower at T₃-T₅, and the level of Qs/Qt was lower at T₂ and T₃ (P＜0.05). Conclusions Intravenous injection of glycopyrrolate can dilate bronchus, reduce intrapulmonary shunt, improve lung compliance, protect lung function without influencing the hemodynamics in the elderly patients undergoing radical resection of lung cancer.

Key words: glycopyrrolate, pulmonary function, pulmonary shunt, aged

中图分类号:

R 734.2

袁艺丹, 刘增, 卢锡华. 格隆溴铵对老年肺癌根治术病人肺功能和肺内分流的影响[J]. 实用老年医学, 2023, 37(7): 662-666.

YUAN Yi-dan, LIU Zeng, LU Xi-hua. Effect of glycopyrrolate on pulmonary function and pulmonary shunt in elderly patients with lung cancer undergoing radical resection[J]. Practical Geriatrics, 2023, 37(7): 662-666.

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