老年人腹部手术硬膜外加全麻低氧血症防治的研究

The clinical study of treatment of perioperative hypoxemia under epidural block combined with general anesthesia for elderly abdominal surgery

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 1 2 3例 ASAI～ 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 +连硬。监测 2 4 h Sp O2 ,术前及术后 1、2、5 d作动脉血气分析。结果 5组中 2 4 h内发生一次或多于一次的低氧血症病人分别为 2 6%、30 %、2 6%、30 %和 2 2 %。 I、 组术后 1、2、5d Pas O2 与术前相比显著下降 , 组术后 1～ 5d 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 应用镇痛药方案或联合应用电刺激治疗能改善老年人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 of 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, group2: with lower abdominal surgery under general anesthesia, group3:general anesthesia combined with epidural block and analgesia for upper abdominal surgery, group4: general anesthesia combined with epidural block and electric stimulation analgesia postoperatively for upper abdominal surgery, group5: general anesthesia combined with epidural block for lower abdominal surgery. SpO 2 was monitored from preoperation to postoperative 24 h 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 lst, 2nd and 5th postoperative day than at preoperation in group 1,2 and 3, but PaO2 was over 70 mm Hg all the time in group3,without change in group 4and 5. Conclusion The above analgesic methods or combined with electric stimulation can improve oxygenation function of elderly.