老年胃切除术病人静脉与硬膜外自控镇痛效果的对比观察

Comparison of Intravenous and Epidural Patient-control Analgesia in the Elderly after Gastrectomy

目的 比较老年人施行胃切除术用静脉与硬膜外自控镇痛的效果。方法 选取ASAⅠ～Ⅱ级 ,年龄 >70岁 ,拟施胃切除手术的病人 30例 ,随机分成 2组 :A组 (n =15 ) ,常规全麻后 ,采用静脉内注射吗啡PCA进行术后镇痛 ;B组 (n =15 ) ,常规全麻后 ,采用硬膜外内注射布比卡因和芬太尼PCEA进行术后镇痛。分别观察术后 5d内 ,病人VAS评分 ,精神状态 ,胃肠道功能 ,心肺功能的情况。结果 B组术后前 2dVAS评分均低于A组 (P <0 0 5 ) ,病人精神状态良好 ,胃肠道及心肺功能未受明显影响。结论 老年人胃切除术后PCEA镇痛效果优于PCA镇痛。

Objective To compare the effect of intravenous and epidural patient-control analgesia in the elderly after gastrectomy. Methods 30 gastrectomy patients ASA I-II who were older than 70 were randomly divided into 2 groups. In group A (n=15): general anesthesia followed by postoperative patient-controlled analgesia (PCA) with intravenous morphine; In group B (n=15): general anesthesia followed by postoperative patient -controlled epidural analgesia (PCEA) with a mixture of bupivacaine and fentanyl. Visual analog scale, mental status, gastrointestinal function and cardiorespiratory function were measured in 5 days after operation. Results In group B visual analog scale was low significantly in the initial 2 days postoperation compared with group A (P<0.05). The patients' mental status, gastrointestinal function and cardiorespiratory function were very well. Conclusion After gastrectomy in the elderly patient, patient-controlled epidural analgesia (PECA) might be better than PCA.