在全身热化疗术中长托宁与东莨菪碱联合应用的临床研究

摘要

Objective To investigate the clinical validity of penehyclidine hydrochloride injection combined with scopolamine in the whole body hyperthermia (WBH). Methods 30 patients, ASA I-II, were randomly divided into three groups- A, B and C group. The patients in A group (n=10) and B group (n=10) intramuscularly injected with penehyclidine hydrochloride (0.02mg/kg) before closing the infrared cabin. C group (n=10) intramuscularly injected with scopolamine (0.01mg/kg) at the same time. If patient had obvious sweat during WBH, additional scopolamine were injected in A and C group, and penehyclidine hydrochloride in B group. Record the time during the esophageal temperature increased to 41. 8℃. The HR, MAP, CVP and incidence of adverse effect were recorded respectively at the time of pre-heating, heating to 39℃, 40℃,41. 8℃, and keeping body temperature at 41. 8℃ for 2 hour. Results The time heating to 41. 8℃ in A group had no significant different with that in the B group (P>0. 05). Compared with C group, A and B group had significant shorter heating time (P<0. 05). Although the HR in A group were faster than that in B group at the time of heating to 40℃ ,41. 8℃ and keeping body temperature at 41. 8℃ for 2 hour, there were no significant difference. The HR in C group at each time were all faster than HR in A and B groups (P<0. 05). After the esophageal temperature increased to 40℃, the MAP decreased along with the HR increase, and the CVP increased. Compared with A and B group, the MAP in C group were significantly decreased, and the CVP were increased. The incidence of adverse effects in B group were significantly increased (P<0. 01). Conclusion Penehyclidine hydrochloride injection combined with scopolamine in WBH can significantly decrease the heating time, keep haemodynamics stability and decrease the incidence of adverse reaction.%目的 探讨全身热化疗术中长托宁与东莨菪碱联合应用的临床可行性.方法 选择30例ASA Ⅰ～Ⅱ级患者,分为长托宁与东莨菪碱联合应用组(A组)、长托宁组(B组)、东莨菪碱组(C组),关舱前A组和B组肌注长托宁0.02mg/kg,C组肌注东莨菪碱0.01mg/kg,术中根据出汗情况A组和C组追加东莨菪碱、B组追加长托宁,现察三组患者的食管温度升至41.8℃所需要的时间,升温前、升温至39℃、40℃、41.8℃、维持41.8℃2h的HR、MAP、CVP及术后不良反应的发生率.结果 A组和B组患者食管温度升至41.8℃所需要的时间相比无统计学差异,A、B组与C组相比的升温时间明显缩短(P＜0.05)；A组在40℃、41.8℃、维持41.8℃ 2h时的HR与B组相比均增快,但无统计学意义,C组在各温度点的HR与A组、B组相比均明显增快(P＜0.05)；当食管温度达到40℃以上,患者的MAP随着心率增快而下降,CVP随着心率的增快而升高,C组与A组、B组相比,MAP明显下降(P＜0.05),CVP明显增高(P＜o.05)；B组和A组、C组相比术后的不良反应明显增加(P＜0.01).结论 在全身热化疗术中长托宁与东莨菪碱联合应用能明显缩短升温时间,维持循环动力学的稳定,并减少不良反应的发生.