老年人肺癌手术后硬膜外镇痛的临床观察

Clinical observation of postoperative thoracic epidural analgesia on surgical treatment of lung cancer in the elderly

目的探讨在老年肺癌手术治疗中应用术后硬膜外镇痛的优越性。方法对40例老年肺癌手术患者,随机分成2组,A组20例采用静吸复合全麻联合硬膜外阻滞、术后硬膜外镇痛,B组20例采用单纯静吸复合全麻、术后传统镇痛。比较两组患者术后疼痛反应情况及术后相关并发症发生情况。结果两组患者均手术切除,围手术期死亡1例,死亡率2.5%。两组病例共发生术后并发症16例,并发症发生率40.0%。采用静吸复合全麻联合硬膜外阻滞、术后硬膜外镇痛的患者,镇痛效果确切,术后肺部并发症的发生明显低于采用单纯静吸复合全麻、术后传统镇痛的患者,差异有统计学意义(P<0.05)。结论在老年肺癌手术治疗中,术后硬膜外镇痛可以提供良好的镇痛效果,减少术后肺部并发症的发生,有利于老年病人的术后康复。

Aim To investigate the excellence of postoperative thoracic epidural analgesia on surgical treatment of lung cancer in the elderly. Methods 40 elderly lung cancer patients undergoing selective pulmonary operation were randomly divided into two groups, in which A group,20 cases, were given combined anesthesia uniting epidural anesthesia plus postoperative thoracic epidural analgesia and B group,20 cases, were given combined anesthesia and postoperative routine analgesia. The visual analogue scale （VAS） at different times and the postoperative complications between the two groups were compared. Results All cases underwent resections, of which 1 case died during perioperative period, mortality rate 2.5% , and 16 patients developed various complications after operation with an incidence of 40. 0%. In group A, the analgesic effect was definite, and the incidence of postoperative pulmonary complications（PPCs） was significantly lower than that in group B （ P 〈 0. 05 ）. Conclusion Application of the postoperative thoracic epidural analgesia in elderly patients with lung cancer has a good analgesic effect, as well as less incidence of postoperative pulmonary complications （PPCs）and recover quickly.