硬膜外腔芬太尼或吗啡胸腔手术后镇痛的呼吸功能观察

Observations on the Respiratory Function using Epidural Fentanyl or Morphine for Post-thoracic Operative Analgesia

报告20例胸腔手术后硬膜外(T_(68))注射芬太尼或吗啡镇痛,观察其用药前后的通气功能及动脉血气变化,与术前对照值比较,痛疼发作时的f增加55%,V_T减少40%,V_c减少74%(P均<0.01)。硬膜外用药后0.5～lh,f减慢,V_T和V_c均基本恢复,通气功能明显改善;芬太尼注药24h和吗啡注药48h内的每分钟通气量及动脉血气均保持正常,也未见临床呼吸抑制表现,提示硬膜外吗啡类药胸腔手术后镇痛一般不出现呼吸抑制,相反可缓解疼痛造成的通气干扰,但1考虑到硬膜外吗啡类药呼吸抑制的诱因是多方面的,故重视用药后呼吸监测仍属必要。

20 post-thoracic operations using epidural fentanyl or morphine analgesia were observed on their respiratory function and blood gas analysis. When the pain attacked,f increased by 55% ,Vt and Vc decreased by 40% and 74% respectively .compared with the preoperative value. While 0.5～lhr after the injection,f、Vt and Vc recovered basically. The minute volumme and the blood gas analysis showed normal with no clinical signs of respiratory depression within 24 hr after fentanyl injection and 48 hr after morphine injection. These indicated that there were no respiratory depression after post-thoracic operative epidural opiates analgesia and that the pain-induced respiratory interferences were lessened. But the other factors of respiratory depression should be considered and it is necessary to pay great attention to the respiration monitoring.