急性阑尾炎患者术中寒战的临床研究

Penehyclidine hydrochloride in prevention of shiver during appendectomy

关键词:  长托宁(盐酸戊乙奎醚)  寒战  预防  急性阑尾炎

Key words:  changtuoning(combimation of penehyclidine hydrochloride)  shiver  prevention  Acute appendicitis

摘要:

目的 探讨长托宁对急性阑尾炎患者术中寒战的预防作用。方法 蛛网膜下腔阻滞麻醉下行急性阑尾炎手术患者120例,随机分为3组: Ⅰ组(对照组),Ⅱ组(长托宁组),Ⅲ组(哌替啶组)。观察三组患者术中寒战的发生率及严重分级；记录静脉注药前1min(T₀)、静脉注药后3min(T₁)、5min(T₂)、10min(T₃)、15min(T₄)、20min(T₅)、30min(T₆)的血氧饱和度(SPO₂)、平均动脉压(MAP)、心率(HR)的变化情况；用药后不良反应的发生情况；注药前1min(T₀)、注药后30min(T₆)、麻醉后30min(T₇)和手术结束时(T₈)体温变化情况。结果 Ⅱ组、Ⅲ组的寒战发生率分别为10％、7.5％,显著低于Ⅰ组的65％(P<0.01),Ⅱ组和Ⅲ组之间比较差异无显著性(P>0.05)；Ⅱ组、Ⅲ组寒战严重程度分级显著低于Ⅰ组(P<0.05),Ⅱ组和Ⅲ组之间比较差异无显著性(P>0.05)。血氧饱和度(SPO₂)的变化,Ⅲ组用药后下降明显,与Ⅰ组和Ⅱ组比较有显著性差异(P<0.01)。平均动脉压(MAP)、心率(HR)、体温,三组变化比较差异均无统计学意义(P>0.05)。Ⅲ组静脉注药后,发生恶心呕吐6例(15％),嗜睡5例(12.5％),明显高于Ⅱ组和Ⅰ组(P<0.05)。结论 麻醉前预防性静脉注射长托宁(0.01mg/kg)具有预防术中寒战发生的作用,效用与预防性静脉注射哌替啶(0.5mg/kg)相似,但长托宁无类似哌替啶的呼吸抑制作用,且无哌替啶高发生率的恶心呕吐、嗜睡不良反应,对血压、心率、体温无影响,在临床预防术中寒战的应用中优于哌替啶。

Abstract:

Objective To evaluate the application of penehyclidine hydrochloride in prevention of shiver during appendectomy. Methods One hundred and twenty patients with acute appendicitis undergoing appendectomy were randomly allocated to received 0.9% saline 5ml (group Ⅰ, n=40), 0.01mg·kg-1 penehyclidine hydrochloride (group Ⅱ, n=40) or 0.5mg·kg-1 pethidine (group Ⅲ, n=40) during the operation. The incidence and degree of shiver during the operation were recorded. Mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SPO₂) were measured 1min before drug administration (T₀), 3min (T₁), 5min (T₂), 10min (T₃), 15min (T₄), 20min (T₅), 30min (T₆) after administration. Axillary temperature were measured at T₀, T₆,0min after subarachnoid anesthesia (T₇), and the end of surgery (T₈).The side effects were also recorded. ResultThe incidence of shiver in penehyclidine hydrochloride and pethidine groups was significantly lower than that in saline group (10% and 7.5% vs 65%, P<0.01); while there was no significant difference between penehyclidine hydrochloride and pethidine groups. The degree of shiver was significantly reduced following penehyclidine hydrochloride and pethidine administration compared to placebo (P< 0.05); while there was no significant difference between penehyclidine hydrochloride and pethidine groups (P>0.05). SPO₂ decreased significantly in pethidine group compared to penehyclidine hydrochloride group and placebo group(P<0.01). There were no significant influences in MAP, HR, axillary temperature among three groups (P>0.05). Following pethidine administration, nausea/vomiting and drowsiness developed in 6 (15%) and 5 cases (12.5%), respectively, which were significantly higher than penehyclidine hydrochloride group and placebo group (P<0.05). ConclusionBoth pethidine and penehyclidine hydrochloride are effective in prevention of the shiver during appendectomy; however, penehyclidine hydrochloride has less adverse effects than pethidine.