老年人上腹部手术后应用PCEA的效果及其对呼吸功能的影响VIP免费

2001年9月第21卷第9期ChinJAnesthesio1．September2001．Vat21．No．9541·临床研究·老年人上腹部手术后应用PCEA的效果及其对呼吸功能的影响汪春荚贺为人祁秀杰杨颐罡邓玲玲潘耀东【摘要】目的观察老年人上腹部手术采用硬膜外阻滞静吸复台垒麻与术后病人自控硬膜外镇痛(PCEA)的疗效及对呼吸功能的影响。方法41例65岁以上ASAI～Ⅱ缎择期上腹部手术的老年病人，随机分为2组。I组：(对照组=2O)术后按需肌肉注射哌替啶50mg]次；11组PCEA组(=21)：术后行PCEA治疗，对比术后镇痛效果并分别于术前和术后1、3、5、7d}划定呼吸功能变化。结果Ⅱ组术后病人的吗啡用量少，VAS评分低，呼吸功能改善明显，尤其是小气遭功能改善较为显著结论上腹部手术的老年病人，联台应用与PCEA可改善术后呼吸功能，而且不良反应少【关键词】老年人；注射，硬膜外；镇痛，病人控制；呼吸功能试验；腹部；外科手术Theeffectofpostoperativepatientcorttrolled-epldural—analgesiaonrespiratoryfunctioninelderlypatientsWANGChunying，HEWeiren，O，Xiwic，eta1．Departmento1．4nesthesioloKy．HuangpuCentralHospitaltShanghgi200002，China【Abstract】Objecti~Toevaluatetheeffectofpostoperativepatient—controlledepidural—analgesia(PCEA)onr~piratoryfunctioninpatientsagedover65years．Methods41AsAI一Ⅱpatients(male22，female19)agedbetween65—8oyears，weighing58—78kg．scheduledforupperabdominalsurgerywelN~dividedrandomlyintotwogroups：controlgroup(=20)andPCEAgroup(月=21)．EpiduralblockperformedatTsqwithanepiduralcatheterinsertedcranially／or4cm．Atestdoseof1．5％]idocaine4—5mlwasgivenviaepiduralcatheter．Whenepidura[blockadewasconfirmed．generalan~tbesiawasinducedwithdi0zepam02mg’kg，etomidate03nag’kg～．fentany]4Fg’kg～andvecuronium0．1mg·．andmaintainedwithepidural0．5％buplvacaineinfusion(6-7mU2h)combinedmthinha[ationotlowconcentrationofisofluraneandintermittentivbolusesoffentanylandvecuronium．Forpostoperadveanalgesiaincontrolgroupintramuscularpathldinew自sgivenondemand；InPCEAgrouptK；EAwasus~ed．Aloadingdese0f3mlof0．15％bupivacaine—mixture(morphine10mgandhaloparido[5mg]015％huplvacaine100mr)followedbycontinuousinfusionof0．5lm1]hSuperimposedbyboLusesof2mlwithalock—outtimeof25min．Themaxin~a[amountofbupivacainemixture58ml／h．1sBruggananscomfcctscaleandRawsayssedationscorewereeva[uatedBP，HR．respiratoryrate(RR)andsp(weremeasuredandrecordedevery30mln4hafteroperationVitalvolume，Formalvitalcapacity．forcedexpiratoryvo]ume(firstsecond：FEVll¨)．PEEP，MMEFweremeasuredbeforeoperationandonIst．3rd．5thand7thpostoperativedaysBloodgasanalysL．wascheckedbeforeoperation．duringoperation(30minand90rainafterinduclionofanesthesia)andthe1st，3rd，5thand7thpostoperativedays．ResultsThetotalatllountofnarcoticin72hl1．36mg(morphineequivalentdose)incontm[groupand5．4naginPCEAgroup．VASwashigherincontrolgroupthanPCEAgroupThepostoperativerespiratoryfunctionwassignlflcant]ybetterinPECAgroup．ConclusionsIneldertypatientafterupper-abdomlnaloperationPECAcangreatlyimprovetherespirator),functionwithbetteranalgesia【Keywords】Aged；Injections，epldura]；．Analgesia．patient．c~ntmlled；Respirator)'functi。ntests：Abdomen；Surgicalprocedures．operative作曹单位：2110002E海市黄浦区中心医院(征春奠、帮为』、)，长春市中心医院(祁秀杰、杨颐罡、邓玲玲)，解放军461医院(潘耀东)维普资讯http://www.cqvip.com542华麻醉学杂占2001年9月第2l卷第9期ChinJAnth．September2(帅1．Vol21．No9本研究采用硬膜外阻滞静吸复合全麻与术后病人自控硬膜外镇痛(PCEA)于老年上愎部手术病人，观察其应用的效果及其对呼吸功能的影响，报告如下。临...