老年人围手术期低氧血症防治的研究

The clinical study of treatment of perioperative hypoxemia in elderly

目的 观察老年病人围手术期低氧血症的发生率及硬膜外镇痛或加用穴位电刺激等对低氧血症的治疗效果。方法 12 3例 ASA ～ 级择期腹部手术老年病人 ,分为 5组 : 组为上腹部手术全麻组 , 组为下腹部手术全麻组 , 组为上腹部手术全麻 +连续硬膜外 (连硬 ) , 组为上腹部手术全麻 +连硬 +电刺激 , 组为下腹部手术全麻 +连硬。监测 2 4小时 Sp O2 ,术前及术后 1、2、5天作动脉血气分析。结果 5组中 2 4小时内发生一次或多于一次的低氧血症病人分别为 2 6%、3 0 %、2 6%、3 0 %和 2 2 % , 、 组术后 1、2、5天 Pa O2 与术前相比显著下降 , 组术后 1～ 5天 Pa O2 与术前相比显著下降 ,但均大于 70 mm Hg, 和 组与术前相比无显著性差异。结论 应用本组镇痛药方案或联合应用电刺激治疗能改善老年手术病人的氧合功能。

Objective To determine the incidence of perioperative hypoxemia in elderly,and the efficacy of treatment with epidural analgesia or combined with electric stimulation Methods One hundred and twenty three elderly,ASA grade Ⅰ Ⅲ,scheduled for elective abdominal surgery under general anesthesia,were divided into 5 groups, group 1:upper abdominal surgery under general anesthesia,group 2:with lower abdominal surgery under general anesthesia,group 3:general anesthesia combined with epidural block and analgesia for upper abdominal surgery,group 4:general anesthesia combined with epidural block and electric stimulation analgesia postoperatively for upper abdominal surgery,group 5:general anesthesia combined with epidural block for lower abdominal surgery SpO 2 was monitored from preoperation to postoperative 24h with Nellcor 200 pulse oxymeter Blood gas were measured before operation and 1st,2nd,5th day after operation Results The incidences of postoperative hypoxemia were 26%,30%,26%,30% and 22% in five groups respectively PaO 2 decreased significantly at 1st,2nd and 5th postoperative day than at preoperation in group 1,2 and 3,but PaO 2 was over 70mmHg all the time in group 3,without change in group 4 and 5 Conclusion The above analgesic methods or combined with electric stimulation can improve oxygenation function of elderly