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目的:探讨盐酸戊乙奎醚用于无痛胃镜麻醉前用药的临床疗效、安全性、不良反应及其最适给药剂量。方法:静脉麻醉下行胃镜检查的120例患者,ASAⅠ～Ⅱ级,随机分为四组(每组30例)。于麻醉前10min分别静脉注射0.9%氯化钠注射液3 ml(A组),盐酸戊乙奎醚0.3mg(B组),0.5mg(C组),1.0mg(D组)。麻醉方法采用不插管的静脉全麻,静脉缓慢推注芬太尼0.75μg·kg~(-1)和异丙酚1.5mg·kg~(-1)。分别测量并记录给实验药物前后各时点的患者心率、平均动脉压、血氧饱和度及口干程度的视觉模拟评分(Visual Analogue Scale,VAS)。结果:A组麻醉后5min心率减慢较麻醉前有显著变化(P<0.05),B、C、D组患者给药后及麻醉后心率较基础值略减慢,给药后5min,10min平均动脉压较基础值略降低,均无显著变化(P>0.05)。B、C、D组患者在给药后5min,10min,术后5min,1h的VAS评分增高,B组(P<0.05),C、D组(P<0.01)与A组差异显著(P<0.01)。B、C组患者术后8h的VAS评分较基础值无明显差异,D组患者术后8h的VAS评分较基础值高(P<0.01)。结论:无痛胃镜麻醉前静脉注射盐酸戊乙奎醚可以有效减少患者的腺体分泌,便于呼吸道管理,并能稳定血流动力学,是一种安全、有效的门诊手术麻醉前用药,且0.5mg为最适给药剂量。
Objective: To investigate the clinical efficacy, safety and side effects of penehyclidine hydrochloride for painless gastroscope before anesthesia and the optimal dosage. Methods: One hundred and twenty patients undergoing gastroscopy underwent intravenous anesthesia, ASA Ⅰ ~ Ⅱ were randomly divided into four groups (30 in each group). 10 ml of 0.9% sodium chloride injection (group A), penehyclidine hydrochloride 0.3 mg (group B), 0.5 mg (group C), and 1.0 mg (group D) intravenously 10 min before anesthesia. The method of anesthesia was intravenous anesthesia without intubation and bolus injection of fentanyl 0.75μg · kg ~ (-1) and propofol 1.5mg · kg ~ (-1) slowly. The visual analogue scale (VAS) of heart rate, mean arterial pressure, oxygen saturation and dry mouth were measured and recorded in patients before and after the experiment. Results: In group A, the heart rate slowed down 5 min after anesthesia compared with that before anesthesia (P <0.05). After administration, the heart rate of patients in groups B, C and D was slightly lower than the baseline value after 5 min and 10 min after administration Arterial pressure slightly lower than the basic values, no significant change (P> 0.05). The VAS scores of patients in group B, C and D at 5 min, 10 min, 5 min and 1 h after administration increased significantly (P <0.05), while those in C and D (P <0.01) 0.01). There was no significant difference in VAS score between 8 and 8 hours after operation in group B and group C, and the VAS score in group D at 8 hours after operation was higher than the baseline (P <0.01). CONCLUSION: Penehyclidine hydrochloride can effectively reduce glandular secretion in patients with painless gastroscopy before anesthesia, facilitate respiratory tract management and stabilize hemodynamics. It is a safe and effective premedication for outpatient surgery and 0.5 mg is the optimal dosage.