格隆溴铵联合新斯的明对腹腔镜手术老年患者术后心血管不良事件的影响

Effect of glycopyrrolate and neostigmine on adverse cardiovascular events after operation in the elderly patients undergoing laparoscopic surgery

中文关键词: 格隆溴铵  阿托品  新斯的明  心血管不良事件  老年

英文关键词: Glycopyrrolate  Atropine  Neostigmine  Adverse cardiovascular events  Aged

中文摘要:

      
目的： 比较格隆溴铵或阿托品联合新斯的明对腹腔镜手术老年患者术后心血管不良事件（ACEs）的影响。
方法： 选择择期行全身麻醉腹腔镜手术的老年患者142例，男69例，女73例，年龄65～80岁，BMI 18～28 kg/m²，ASA Ⅰ或Ⅱ级。将患者随机分为两组：格隆溴铵组（G组）和阿托品组（A组），每组71例。手术结束后且距最后一次给予肌松药的时间至少大于30 min后，进行肌松拮抗，G组静脉给予格隆溴铵4 μg/kg和新斯的明20 μg/kg，A组静脉给予阿托品10 μg/kg和新斯的明20 μg/kg。记录术中和术后72 h内ACEs、严重ACEs发生情况。记录拔管后15、30 min静息和活动（咳嗽）时NRS疼痛评分、Richmond躁动-镇静量表（RASS）评分和改良Aldrete评分等PACU内恢复情况。记录苏醒期躁动、术后24 h口干、恶心、呕吐、谵妄发生情况。
结果： 与A组比较，G组术后心动过速、心肌缺血、ACEs总发生率明显降低（P<0.05），术后24 h G组口干发生率明显升高（P<0.05）。两组无一例发生严重ACEs。
结论： 与阿托品比较，格隆溴铵联合新斯的明用于老年患者腹腔镜手术能够降低术后心动过速、心肌缺血、ACEs总发生率，且无严重ACEs发生，但会升高术后24 h口干发生率。

英文摘要:

      
Objective: To compare the effect of glycopyrrolate or atropine in combination with neostigmine on adverse cardiovascular events (ACEs) after operation in elderly patients undergoing laparoscopic surgery.
Methods: A total of 142 patients scheduled for elective laparoscopic surgery were enrolled, 69 males and 73 females, aged 65-80 years, BMI 18-28 kg/m², ASA physical status Ⅰ or Ⅱ. The patients were randomly divided into two groups: the glycopyrrolate group (group G) and the atropine group (group A), 71 patients in each group. After the last administration of muscle relaxants for more than 30 minutes, antagonizing residual neuromuscular blockade was performed. Glycopyrrolate 4 μg/kg and neostigmine 20 μg/kg were given intravenously in group G, atropine 10 μg/kg and neostigmine 20 μg/kg were given intravenously in group A. The incidence of ACEs and severe ACEs during operation and 72 hours after operation were recorded. Recovery situation in PACU such as NRS scores at rest and coughing, Richmond agitation-sedation scale (RASS) score, and modified Aldrete score 15 and 30 minutes after extubation were recorded. Emergence agitation, dry mouth, nausea, vomiting, and delirium 24 hours after operation were recorded.
Results: Compared with group A, the total incidence of ACEs, tachycardia, and myocardial ischemia after operation were significantly decreased in group G (P < 0.05), the incidence of dry mouth 24 hours postoperatively was significantly increased in group G (P < 0.05). There was no severe ACEs occurred in the two groups 72 hours after operation.
Conclusion: Compared with atropine, glycopyrrolate combined with neostigmine in elderly patients undergoing laparoscopic surgery can reduce the incidence of cardiac tachycardia, myocardial ischemia, and total ACEs after operation, and there was no severe ACEs occurred. However, it can increase the incidence of dry mouth 24 hours after operation.