术后镇痛对老年人上腹部手术后肺功能的影响

The effects of postoperative epidural analgesia on pulmonary function after upper abdominal surgery in geriatric patients

３２例 ＡＳＡ Ⅱ～Ⅲ级择期行上腹部手术（ＵＡＳ）的老年患者随机分成两组：对照组（ｎ＝１６）和术后每６小时用 ０． １２５％丁听卡因十芬太尼０．０２５ｍｇ １０ｍｌ行硬膜外镇痛（ＰＥＡ）组（ｎ＝１６），分析两组患者术前，拔管时，术后４、８和２４小时的呼吸频率（ＲＲ）、潮气量（ＶＴ）、分钟通气量（ＭＶ）和动脉血ｐＨＰａＯ２、ＰａＣＯ２、ＮＣＯ０－３、ＢＥ－Ｂ、Ｏ２Ｓａｔ。结果表明：虽术后持续鼻导管吸氧，对照组仍出现严重的呼吸抑制和酸碱平衡紊乱，尤以术后８小时内，特别是４小时内最严重；而镇痛组则程度轻微且无明显缺氧、二氧化碳蓄积和酸碱平衡失调。可见用０．１２５％丁哌卡因十芬太尼０．０２５ｍｇ １０ｍｌ行ＰＥＡ能改善老年患者的术后肺功能。但在ＰＥＡ期间仍应继续进行呼吸监测，并常规给予吸氧至少８小时。//

Thirty-two old patients having had elective upper abdominal surgery were randomly divided into two groups. The patients in group I (n= 16)received epidural 10ml saline as control and in group I (n= 16)did 0. 125 % bupi- vacaine and fentanyl 0. 025rug in 10ml saline every 6 hours. Respiratory freguency,tidal volume,minute volume and arterial blood PH,PaO2,PaCO2,BE- B,HCO3-and O2Sat were examined 4 hours, 8 hours and 24 hours postoperatively and compared with the preoperative data. The results showed profound postoperative respiratory inhibition anc acidosis happened in group i, within postoperative 8 hours especially in the lst 4 hours, despite inhaling oxyger throughout the whole period,but the changes were slight in group I without hypoxia,hypercapnia and acid-bas e disturbance. lt is concluded that postopelative epidural analgesia may impove the postoperative pulmonary functior in old patients,but continuous monitoring of respiratory function and inhaling oxygen at least 8 hours postoperatively should be routinly applied.