开胸术后硬膜外镇痛对血氧饱和度和呼气末二氧化碳分压的影响

Effects of epidural analgesia on oxygen saturation and end-tidal CO_2 pressure after thoracotomy

为观察硬膜外镇痛对血氧饱和度（ＳｐＯ２）和呼气末二氧化碳分压（ＰｅｔＣＯ２）的影响，６０例ＡＳＡⅠ－Ⅱ级择期开胸手术的患者随机分为４组。Ⅰ组为对照组，Ⅱ组０．１５％布比卡因１０ｍｌ，Ⅲ组吗啡２ｍｇ加氟哌啶１ｍｇ，Ⅳ组曲马多５０ｍｇ。结果：硬膜外镇痛效果良好，维持时间吗啡最长，布比卡因最短。各组间相同时点ＢＰ、ＨＲ、ＳｐＯ２、ＰｅｔＣＯ２均无显著差异（Ｐ＞０．０５），各组内不同时点与术前比较ＢＰ、ＨＲ、ＰｅｔＣＯ２无明显差异，仅ＳｐＯ２在回ＩＣＵ而未吸Ｏ２前低于术前水平（Ｐ＜０．０５），其余各时点亦无差异。

To observe the effects of epidural analgesia on oxygen saturation and end-tidal CO2 pressure,60 patients subjected to elective thoracotomy were randomly divided into 4 groups.The patients in group I received intravenous pethidine 50～100 mg as control,groupⅡ-epidural 0.15% bupivacaine 10 ml,group Ⅲ-epidural morphine 2 mg and droperidol 1 mg,and group Ⅳ-epidural tramadol 50 mg.BP,HR,SpO2,and PetCO2 were monitored and compared with preoperative data.The maintaince time and the effects of analgesia were recorded.Results showed that good analgesic effects were produced in group Ⅱ,Ⅲ and Ⅳ.The maintaince time of morphine was longest and bupivacaine was shortest.The differences of BP,HR,SpO2 and PetCO2 were insignificant(P>0.05)among 4 groups.The differences of BP,HR and PetCO2 in each group were insignificant(P>0.05)compared with preoperaitve data.The levels of SpO2 in each group were lower(P<0.05)than that of preoperative data after the patients returned in ICU and not inhaled oxygen,but after patient inhaled oxygen the levels of SpO2 were insignificant (P>0.05).It is suggested that postoperative epidural analgesia would not produce respiratory depression if the dose of analgetic is administrated properly.