目的 探讨盐酸戊乙奎醚对老年心脏瓣膜置换术患者微循环的影响. 方法 2011年6月至2013年12月在我院接受心脏瓣膜置换术的老年患者84例,随机分为盐酸戊乙奎醚组(Ⅰ组)和对照组(Ⅱ组),Ⅰ组在麻醉诱导后静脉注射盐酸戊乙奎醚0.02 mg/kg;Ⅱ组在诱导后给予等容量的生理盐水,分别在诱导后即刻(T1)、肛温降至33℃时(T2)、停体外循环(CPB)时(T3)、术毕(T4)采集血标本检测动脉血乳酸(Lac)、动静脉血氧压差(Pa-VO2)、动静脉血氧含量差(Ca-jvO2),同时记录术中尿量、输液量、直肠及鼻咽复温时间及心脏自动复跳率. 结果 Ⅰ组尿量明显多于Ⅱ组(P＜0.05),Ⅰ组鼻咽复温及直肠复温时间明显短于Ⅱ组(P＜0.05),自动复跳率高于Ⅱ组(P＜0.05).与T1时刻比较,Ⅰ组及Ⅱ组患者的Lac水平在T2、T3、T4明显升高(P＜0.05),Pa-VO2、Ca-jvO2在T2、T3、T4明显降低(P＜0.05);在相同时间点Ⅱ组Lac水平升高幅度明显高于Ⅰ组(P＜0.05),Pa-VO2、Ca-jvO2下降幅度高于Ⅰ组(P＜0.05). 结论 盐酸戊乙奎醚在老年心脏瓣膜置换术时能够增加周围组织的氧供和促进Lac代谢,对改善微循环有重要作用.%Objective To explore the effects of penehyclidine hydrochloride on microcirculation in elderly patients receiving heart valve replacement.Methods Eight-four elderly patients underwent heart valve replacement in our hospital from June 2011 to December 2013 were randomly divided into penehyclidine hydrochloride group (Ⅰ group) and control group (Ⅱ group).The patients of Ⅰ group received penehyclidine hydrochloride 0.02 mg/kg after induction of anesthesia,and the patients of Ⅱ group were given equal volume of saline.The blood samples were collected to detect arterial blood lactic acid (Lac),differences of arteriovenous oxygen pressure (Pa-VO2) and differences of arteriovenous oxygen content (Ca-jvO2) after induction (T1),at the time of anal temperature drop to 33 ℃C (T2),at termination of CPB (T3) and at the end of the surgery(T4),meanwhile the intranperative volume of infusion and urine,rewarming time in rectum and nasopharyngeal,auto-rebeat rate of heart were also recorded.Results The intranperative volume of urine in Ⅰ group was more than that in Ⅱ group (P＜0.05).The rewarming time of rectum and nasopharyngeal in Ⅰ group were shorter than those in Ⅱ group (P＜0.05).The rate of automatic heart resuscitating in Ⅰ group was higher than that in Ⅱ group (P＜0.05).Compared with T1,the Lac level of Ⅰ and Ⅱ group increased significantly at T2,T3 and T4(P＜0.05) while Pa-VO2 and Ca-jvO2 decreased obviously (P＜0.05).Compared with Ⅱ group,Lac level of Ⅰ group increased significantly at T2,T3 and T4 (P＜0.05) while Pa-VO2 and Ca-jvO2 decreased significantly (P＜0.05) ; Conclusions Penehyclidine hydrochlorid can increase oxygen supply for the surrounding tissue and promote the metabolism of Lac in the elderly patients undergoing heart valve replacement,and it plays an important role in improving microcirculation.
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