格隆溴铵对腹腔镜胆囊切除术患者围手术期循环的影响

Effects of the use of glycopyrrolate on the perioperative circulation undergoing laparoscopic cholecystectomy

摘要:

目的 探讨麻醉前静脉给予格隆溴铵对腹腔镜胆囊切除术（LC）患者围手术期循环的影响。方法 选择2024年3月－2024年6月于该院择期行LC的患者88例。随机分为格隆溴铵组（G组，n=44）和生理盐水组（C组，n=44）。在排除G组3例和C组4例后，最终纳入G组41例和C组40例。麻醉诱导前10 min，G组给予静脉注射格隆溴铵4 μg/kg（生理盐水稀释至5 mL），C组给予生理盐水5 mL，均随即恒速静脉泵注1 μg/kg右美托咪定10 min。记录输注格隆溴铵/生理盐水前即刻（T₀）、输注后5 min（T₁）、输注后10 min（T₂）、气管插管后1 min（T₃）、切皮即刻（T₄）、气腹开始后2 min（T₅）、游离胆囊时（T₆）和气管拔管后1 min（T₇）的心率（HR）和平均动脉压（MAP）。记录术中丙泊酚用量、罗库溴铵用量、舒芬太尼用量、瑞芬太尼用量、口腔分泌物评分、麻醉恢复室（PACU）恢复时间、术后首次排气时间和围手术期不良反应发生情况。结果 G组T₂、T₃、T₄、T₅和T₆时点HR明显高于C组，T₁、T₂、T₃、T₄和T₅时点MAP明显高于C组，差异均有统计学意义（P < 0.05）；G组T₂时点HR明显低于T₀时点，T₇时点明显高于T₀时点，C组T₁、T₂、T₄、T₅和T₆时点HR明显低于T₀时点，T₇时点明显高于T₀时点，差异均有统计学意义（P < 0.05）；G组T₁和T₂时点MAP明显高于T₀时点，T₆时点MAP明显低于T₀时点，C组T₄、T₅和T₆时点MAP明显低于T₀时点，差异均有统计学意义（P < 0.05）；G组口腔分泌物评分明显低于C组，差异有统计学意义（P < 0.05）；G组术中心动过缓发生率明显低于C组，差异有统计学意义（P < 0.05）；G组术后24 h口干发生率明显高于C组，差异有统计学意义（P < 0.05）；两组患者T₀、T₁和T₇时点的HR，以及T₀、T₆和T₇时点的MAP比较，差异均无统计学意义（P > 0.05）；两组患者手术时间、术中丙泊酚用量、瑞芬太尼用量、舒芬太尼用量、罗库溴铵用量、阿托品使用率、术中低血压发生率、PACU恢复时间、术后首次排气时间和恶心呕吐发生率比较，差异均无统计学意义（P > 0.05）；两组患者术后24 h均未发生谵妄。结论 麻醉前静脉注射格隆溴铵应用于LC，可减少心动过缓的发生，维持术中循环的稳定，且对术后谵妄和恶心呕吐无明显影响。值得临床推广应用。

Abstract:

Objective To investigate the effect of the use of glycopyrrolate before anesthesia on the perioperative circulation of patients undergoing laparoscopic cholecystectomy (LC).Methods 88 patients undergoing LC from March to June in 2024 were enrolled and randomly divided into two groups: the glycopyrrolate group (group G) and the control group (group C), with 44 patients in each. Three patients from group G and four from group C were excluded, leaving 41 patients in group G and 40 patients in group C. Ten minutes before anesthesia induction, group G received an intravenous dose of 4 μg/kg glycopyrrolate diluted to 5 mL with normal saline. The control group received an equal volume of normal saline. Both groups then received an intravenous infusion of dexmedetomidine at 1 μg/kg over 10 minutes. Heart rate (HR) and mean arterial pressure (MAP) were monitored immediately before infusion of glycopyrrolate/saline (T₀), 5 min after infusion (T₁), 10 min after infusion (T₂), 1 min after tracheal intubation (T₃), immediately at skin incision (T₄), 2 min after pneumoperitoneum (T₅), dissociating the cholecyst (T₆), and 1 min after tracheal tube drawing (T₇). Intraoperative amounts of propofol, rocuronium bromide, sufentanil, remifentanil, oral secretion score, PACU stay time, first postoperative flatus time and the occurrence of perioperative adverse reactions were observed.Results HR at T₂, T₃, T₄, T₅, and T₆ time points was significantly higher in group G than in group C, while MAP at T₁, T₂, T₃, T₄, T₅ time points was also significantly higher in group G (P < 0.05). HR at T₂ time points in Group G was significantly lower than that at T₀, while T₇ was significantly higher than that at T₀ time points. In Group C, HR at T₁, T₂, T₄, T₅, and T₆ time points was significantly lower than that at T₀ time points, while T₇ time points was significantly higher than that at T₀ time points, with the differences being statistically significant (P < 0.05). In Group G, MAP at T₁ and T₂ time pointswas significantly higher than that at T₀, and MAP at T₆ was significantly lower than that at T₀ time points, and in Group C, MAP at T₄, T₅ and T₆ time points was significantly lower than that at T₀ time points, and the differences were all statistically significant (P < 0.05); Oral secretion was lower in group G compared to group C, with a significant difference (P < 0.05). The incidence of bradycardia was significantly lower in group G compared to group C (P < 0.05). The incidence of oral dryness within 24 h postoperatively was higher in group G compared to group C (P < 0.05). There were no significant differences of HR at T₀, T₁, and T₇ time points, MAP at T₀, T₆, and T₇ time points between the two groups (P > 0.05); There were no significant differences of operation time, propofol usage, sufentanil usage, remifentanil usage, rocuronium bromide usage during operation, rate of atropine use, incidence of intraoperative hypotension, PACU stay time, first postoperative flatus, and nausea vomiting rate between the two groups (P > 0.05); No delirium occurred in either group of patients 24 h after the operation.Conclusion Use of glycopyrrolate before anesthesia can be effectively applied to patients undergoing LC, is beneficial in reducing the incidence of bradycardia, maintaining the stability of intraoperative circulation, and has no significant effect on the incidence of postoperative delirium and nausea and vomiting. It is a worthy clinical application.