防治老年人术后低氧血症的临床研究

Prevention of postoperative hypoxemia in the aged:a clinical study

目的提高老年人麻醉质量,减少术后低氧血症的发生率,减少手术室内空气污染。方法美国麻醉协会评分标准(ASA)Ⅱ级,择期行中卜腹部手术病人178例,随机分组:Ⅰ组为异丙酚靶控输注静脉麻醉(TCI)联合硬膜外阻滞93例,Ⅱ组为对照组以异丙酚(TCI)85例。结果Ⅰ组病人的静脉舒芬太尼、异丙酚和维库溴胺用量、苏醒时间均减少或缩短,且较对照组差异有统计学意义(P<0.01)。Ⅰ组中术后需要催醒33例及出现躁动2例病人较对照组相应的68例及13例差异有统计学意义(P<0.01),但两组都无病人术中知晓。Ⅰ组轻度低氧血症者24、重度低氧血症者2例较对照组相应的49例、6例差异有统计学意义(P<0.01)。结论异丙酚TCI联合硬膜外阻滞,能保证老年人中上腹手术的麻醉深度,可减少阿片类药物及肌松药用量,苏醒较快而且质量好,较早拔管,便于术后镇痛,在降低术后低氧血症发生率方面有一定的帮助。

Objective To improve the quality of anesthesia, decrease occurrence of postoperative hypoxemia and minimize intra-operative air pollution from volatile anesthetics in the aged. Methods One hundred and seventy-eight patients, ASA Ⅱ, aged from 65-85 years who underwent abdominal surgery were enrolled to this study. The patients were randomized into two groups： Group Ⅰ （n=93）, where Propofol TCI combined with epidural block was used, and Group Ⅱ （n=85）, where propofol TCI was used. Results The total amount of propofol, sufentanil and vecuronium in Group Ⅰ was less than that in Group n （P〈0.01）, and the awakening time in Group Ⅰ was shorter than that in Group Ⅱ （P〈0.01）. Restlessness after awakening was observed in 2 patients of Group Ⅰ versus 13 patients in Group n （P〈 0.01）. Mild postoperative hypoxemia was observed in 24 patients and severe hypoxemia in 2 patients of Group Ⅰ versus 49 and 6 patients of Group n （P 〈 0.01）. There was no difference in the effect on PCA between the two groups （P 〉 0.05）. Conclusions Propofol TCI combined with epidural block is more beneficial than TCI alone to the patients in abdominal surgery in that it offers less dosage of narcotics and muscle relaxants and better awakening, which is helpful for preventing postoperative hypoxemia and improving anesthesia quality in the aged.