镇痛方法对老年普胸患者术后早期谵妄的影响

Effect of analgesia on early postoperative delirium in the elderly underwent thoracic surgery

目的探讨镇痛对老年人普胸手术术后谵妄(POD)的影响。方法普胸手术老年患者271例随机分为三组:A组,84例,硬膜外自控镇痛(PCEA);B组,99例,静脉自控镇痛(PCIA);C组,88例,分次肌肉注射镇痛药。比较术后48h内的镇痛效果、谵妄发生率及心肺并发症的发生率。结果 A、B组术后镇痛效果均优于C组(P<0.05);A组活动时疼痛轻于B组(P<0.05)。C组谵妄发生率为18.18%,显著高于A组的2.38%和B组的8.08%(P<0.05)。A组和B组心肺并发症的发生率分别为38.10%和47.47%,均显著低于C组的72.73%(P<0.01)。结论与分次肌肉注射镇痛药比较,老年人普胸术后PCEA及PCIA镇痛效果较好,术后早期POD及心肺并发症发生率低。

Objective To investigate the impact of analgesia on early postoperative delirium（POD） in the elderly underwent thoracic surgery.Methods A total of 271 thoracic elderly patients was randomly divided into three groups of A（84 cases,treated with patient-controlled epidural analgesia）,B（99 cases,treated with patient-controlled intravenous analgesia） and C（88 cases,treated with intramuscular analgesia）.The efficacy of analgesia,the incidence rates of POD and postoperative complications were compared.Results The efficacy of analgesia was better in groups of A and B than that in group C（P〈0.05）,which of reducing movement pain was better in group A than that in group B（P〈0.05）.The incidence of POD in group C was 18.18%,which was higher than 2.38% in group A or 8.08% in group B（P〈0.05）.The incidence rates of cardiopulmonary complication in groups of A and B were 38.10% and 47.47%,which were lower than 72.73% in group C（P〈0.05）.ConclusionCpmpared to intramuscular analgesia,postoperative patient-controlled epidural or intravenous analgesia is better in providing analgesia and reducing the incidence rates of POD and postoperative cardiopulmonary complications in thoracic elderly patients.