| Objectives To investigate the clinical effects of dexmedetomidine(Dex)complex Penehyclidine hydrochloride(PHC)before anesthesia induction for elderly laparoscopic surgery patients with mild to moderate obstructive ventilation dysfunction.To provide a clinical basis for the rational application of anesthesia-related drugs in elderly patients with mild to moderate obstructive ventilation dysfunction.Method The patients(60-75 years old)underwent comprehensive preoperative examination and preparation after admission,and were diagnosed with mild to moderate obstructive ventilation dysfunction,and were evaluated by the attending anesthesiologist after reaching ASA grade 2 or grade 3.It was randomly divided into two groups(n=30): Penehyclidine hydrochloride group(group P),dexmedetomidine add penehyclidine hydrochloride group(group D + P).Dose for the trial intervention:penehyclidine hydrochloride 10 μg/kg in P(20 ml in saline);D + P: dexmedetomidine0.4 μg/kg and penehyclidine hydrochloride 10 μg/kg(20 ml in saline).The same intravenous infusion was used in both groups: constant intravenous infusion using the German B.Braun TCI anesthesia infusion pump 10 minutes before anesthesia induction,and the time was set to 10 minutes.Sufentanil citrate injection was then given 0.3 μg/kg,propofol injection 2 mg/kg,midazolam injection 0.05 mg/kg,cis-atracurium 0.2mg/kg for anesthesia induction.After the patient’s consciousness disappears,blood pressure,heart rate are stable,and the muscle relaxation effect is satisfactory,the tracheal intubation is intubated through direct vision,and the correct position of the endotracheal tube is confirmed by two methods: direct observation and auscultation,and then connected to the Datex-Ohmeda Aespire anesthesia machine.All patients were in volume-controlled ventilation mode,and respiratory parameters were adjusted according to each patient’s weight: Tidal Volume(VT)was 6 ml/kg,respiratory rate(RR)was 12 breaths/min,I:E was 1:2,oxygen concentration Fraction of inspiration O2(Fi O2)was 50%,and oxygen flow was 2 L/min.After establishing artificial pneumoperitoneum,the pneumoperitoneum pressure was set to be 12 mm Hg.The respiratory parameters were adjusted: VT was 6-8 ml/kg,RR was 14 times/min,PEEP5 cm H2O,and the remaining parameters were set as before.Anesthesia maintenance: the patient continued to inhale sevoflurane(regulating the fluctuation of the concentration of sevoflurane by about 1 MAC),continuously pumped propofol 1.5 mg/kg/h,refentanil 10 μg/kg/h,and maintained the patient’s entropy index in the range of 40-60.The depth of anesthesia was adjusted according to the entropy index and SPI value,hemodynamic indicators and surgical operation.Meanwhile,relevant respiratory parameters were adjusted according to the PETCO2 level to maintain CO2 between 35 and 45 mm Hg.During the operation,according to the hemodynamic situation,the corresponding drug symptomatic treatment is given.Four monitoring moments were set:artificial pneumoperitoneum(T1),pneumoperitoneum 30 min(if the pneumoperitoneum time exceeds one hour,it is collected every half hour to obtain the average)(T2),completion of surgery(T3),and 24 hours after surgery(T4).Tidal Volume(VT),peak airway pressure(Ppeak),positive end-expiratory pressure(PEEP)were recorded at T1,T2,and T3,and dynamic lung compliance(Cdyn)was calculated.Radial artery blood was collected,blood gas was detected,Pa O2,Pa CO2 were recorded,Oxygen Index(OI),respiratory index(RI)were calculated,alveola-arterial oxygen partial pressure difference(A-a DO2)was recorded,and 24 hours after surgery(T4)of the lungs were recorded.Results1.The differences on general condition,including age,gender,BMI,ASA grade(Ⅱ/Ⅲ),and FEV 1/FVC were not statistically significant(P> 0.05).2.The differences between the two groups in the intraoperative conditions,pneumoperitoneum time,the volume of loss blood,and infusion volume were not statistically significant(P> 0.05).3.The patients in the two groups established pneumoperitoneum T1,Ppeak in P group was higher than that in D+P group,and the difference was statistically significant(P<0.05).Cdyn in P group was lower than that in D+P group,the difference was statistically significant(P<0.05)and the OI of P group was lower than that in D+P group,and the difference was statistically significant(P<0.05).The RI of group P was higher than that of group D+P with statistical significance(P<0.05).The VD/VT(%)in group P was higher than that in group D+P,and the difference was statistically significant(P<0.05).A-a DO2 in P group was higher than that in D+P group,and the difference was statistically significant(P<0.05).4.The patients in the two groups established pneumoperitoneum for 30 min T2,Ppeak in P group was higher than that in D+P group,and the difference was statistically significant(P<0.05).And the Cdyn in P group was lower than that in D+P group,and the difference was statistically significant(P<0.05)and the OI of P group was lower than that in D+P group,and the difference was statistically significant(P<0.05).The RI of group P was higher than that of group D+P,and the difference was statistically significant(P<0.05).The VD/VT(%)in group P was higher than that in group D+P,and the difference was statistically significant(P<0.05).A-a DO2 in P group was higher than that in D+P group,and the difference was statistically significant(P<0.05).5.After the completion of surgery T3,Ppeak in P group was higher than that in D+P group,and the difference was statistically significant(P<0.05).Cdyn in P group was lower than that in D+P group,and the difference was statistically significant(P<0.05)and the OI of P group was lower than that in D+P group,and the difference was statistically significant(P<0.05).The RI of group P was higher than that of group D+P,and the difference was statistically significant(P<0.05).The VD/VT(%)in group P was higher than that in group D+P,and the difference was statistically significant(P<0.05).A-a DO2 in P group was higher than that in D+P group,and the difference was statistically significant(P<0.05).6.The incidence of hypoxemia in the two groups at 24 hours after surgery was 3%in P group and 0% in D + P group,the differences were not statistically significant(P>0.05).Conclusion The use of dexmedetomidine complex Penehyclidine hydrochloride in laparoscopic surgery in elderly patients with obstructive ventilation dysfunction is more significant than the pulmonary protective effect of Penehyclidine hydrochloride alone. |
