不同镇痛模式对老年患者术后氧合影响的研究

Clinical study on the effect of different antalgic modes on postoperative arterial oxygenation in elderly patients

目的 观察老年患者术后在不同镇痛模式下氧合状况及低氧血症的发生率 ,探讨其防治方法。 方法 6 0例老年患者根据术后采用不同的镇痛模式随机分为 3组 :硬膜外自控镇痛、静脉点滴 (静脉 )持续镇痛、肌肉注射 (肌注 )镇痛组 ,每组各 2 0例 ,监测 2 4h氧饱和度 (SpO2 ) ,分别采自术前、术后第 4、2 4、4 8h动脉血气。 结果 硬膜外自控镇痛、静脉持续镇痛、肌注镇痛组 2 4h内发生 1次或多于 1次的低氧血症患者分别为 2 1%、36 %、32 % ,硬膜外镇痛组 4 8h内氧分压 (PaO2 )、二氧化碳分压 (PaCO2 )和术前比较差异无显著性 ,静脉持续镇痛、肌注镇痛组术后 4、2 4hPaO2 、PaCO2与术前比较显著下降 ,但均大于 70mmHg。 结论 硬膜外自控镇痛方法对老年患者术后的氧合抑制较少 ,减少了低氧血症的发生。

Objective To observe the degree of arterial oxygenation and the incidence of hypoxaemia by different antalgic modes in elderly patients postoperatively, and to investigate the way of prophylaxis and treatment. Methods Sixty elderly patients by different postoperative antalgic modes were randomly divided into three groups with 20 in each: patient-controlled epidural analgesia group, continuously intravenous infusion analgesia group and intramuscular injection analgesia group. The oxygen saturation was monitored during 24 hours and the arterial blood gases were measured immediately before and 4, 24 and 48 hour after operation. Results The rates of hypoxaemia occurring once or more in patient-controlled epidural analgesia group, continuously intravenous infusion analgesia group and intramuscular injection analgesia group were 21%, 36% and 32% respectively . There were no significant differences in PaO 2 (arterial PO 2) and PaCO 2 (arterial PCO 2) between postoperative 48 hour and immediately before operation in patient-controlled epidural analgesia group. PaO 2 and PaCO 2 at 4 and 24 hour after operation were significantly lower than those immediately before operation, and all were over 70 mmHg. Conclusions Patient-controlled epidural analgesia may improve the degree of arterial oxygenation and lower the incidence of hypoxaemia after operation in elderly patients.