Effect Of Penehyclidine Hydrochloride Pretreatment On Pulmonary Funtion And Pulmonary Inflammatory Response During Non-thoracotomy In Patients With Chronic Obstructive Pulmonary Disease

Objective To investigate the effects of intravenous pretreatment penehyclidinehydrochloride on respiratory mechanics and pulmonary funtion and pulmonaryinflammatory responseduring non-thoracotomy in patients with chronic obstructivepulmonary disease.Methods Sixty ASA II or III patients with chronic obstructive pulmonary disease, aged48~82yr，weighing45~76kg，scheduled for elective non-thoracotomy under generalanesthesia were randomly divided into3groups (n=20each): Control group (group I)was pretreated with saline4ml30min before ventilation (T0), group II was pretreatedwith penehyclidine hydrochloride0.01mg/kg-,4ml30min before ventilation,group III was pretreated with penehyclidine hydrochloride0.02mg/kg,4ml.Anesthesia was induced with midazolam0.04mg/kg、sufentanil0.4ug/kg，cis-atracurium0.15mg/kg and propofol1.5mg/kg. The patients were trachedintubated and mechanically ventilated. Fresh gas flow was set at2l/min, Vt at10ml/kg, I:E1:2during ventilation. PETCO2was maintained with iv infusion ofremifentanil6ug·kg-1·h-1, propofol5mg·kg-1·h-1and cis-atracurium0.2mg·kg-1·h-1.The auditory evoked potential index was maintained at20-25during operation.Airway peak pressure (Ppeak), airway plateau pressure (Pplat), airway resistance (Raw)and dynamic lung compliance (Cdyn) were measured at30min after ventilation (T1),60min after ventilation (T2) and120min after ventilation (T3); Arterial bloodsamples were obtained at T0and T3for blood analysis and recorded PH, SaO2,SpO2, oxygenation index (OI), respiratory index (RI),physiologic dead spacefraction (VD/VT) and alveolar-arterial oxygen gradiant （P(A-a)O2） were calculated;The blood sample (3ml) were then drawn from the radial artery at T0and T3for detecting the plasma concertrations of TNF-α、IL-8and IL-10by enzyme-linkedimmunosorbent assay;The occurrence of postoperative complications (PPCs) wasrecorded within72h after operation.Results Compared with group I, the Ppeak, Pplatand Rawwere significantlydecreased,while the Cdynwas significantly increased at each time point afteradministration in group II and group III（P<0.05）,and there were no significantlydifference in the parameters of respiratory mechanics at each time point between groupII and group III （P>0.05）; Compared with group I,OI was significantlyincreased,while RI, VD/VTand P(A-a)O2were significantly decreased at T3ingroup II and group III（P<0.05）; There were no significantly difference at each timepoint between group II and group II（IP>0.05）; Compared with T0, TNF-α、IL-8andIL-10were significantly increased at T3in group I,group II and group III（P<0.05）;Compared with group I, TNF-α、IL-8and IL-10were significantlydecreased at T3in group II and group III（P<0.05）；There were no significantlydifferences at each time point between group II and group II（IP>0.05）;Compared withgroup I, the occurrence of postoperative complications (PPCs) within72h afteroperation were significantly lower in group II and group III（P<0.05）, there wereno significantly differences at each time point between group II and group III（P>0.05）.Conclusion0.01mg/kg hydrochloride Penehyclidine pretreatment can not onlyimprove respiratory mechanics and pulmonary funtion but also reduce pulmonaryinflammatory response and the occurrence of postoperative complications (PPCs)within72h after operation during non-thoracotomy in patients with chronic obstructivepulmonary disease.