摘要
目的:探讨剖胸术后胸部硬膜外镇痛对术后呼吸功能的影响。方法:33例择期剖胸手术病人随机分为硬膜外丁哌卡因-芬太尼镇痛组(Ⅰ组,n=10)、硬膜外丁哌卡因-吗啡镇痛组(Ⅱ组,n=12)和对照组(Ⅲ组,n=11)术后进行镇痛治疗,监测镇痛效果(VAS评分)和手术前后呼吸功能的动态改变。结果:(1)Ⅰ、Ⅱ组病人术后获得满意的镇痛效果,VAS评分明显低于Ⅲ组(P<0.01),以Ⅱ组效果最佳。(2)Ⅰ、Ⅱ组病人术后呼吸平静,VT、MV、VC、FVC、FEVI和MVV等均高于Ⅲ组,Ⅲ组病人呈浅快式呼吸。(3)术后三组病人的PaO_2与SaO_2均明显低于术前水平(P<0.05),A-aDO_2增大(P<0.05),七日内均不能恢复。其中,Ⅰ、Ⅱ组病人的平均PaO_2与SaO_2明显高于Ⅲ组(P<0.01),A-aDO_2亦较Ⅲ组小(P<0.01),而且上述指标的恢复Ⅰ、Ⅱ组较Ⅲ组快。结论:胸部硬膜外镇痛能够显著改善剖胸手术后病人的通气和换气功能。
Objective:To evaluate the effect of thoracic epidural analgesia on postoperative respiratory function in patients underwent thoractomy.Method:Thirty-three adult patients scheduled for thoractomy were randomly divided into epidural hupivacaine-fentanyl group (group Ⅰ,n=10),epidural hupivacaine-morphine group(group Ⅱ,n=12) and coniral group (group Ⅲ,n=11).Epidural analgesia was performed in group Ⅰ and group Ⅱ after operation,meanwhile conventional intramuscular pethidine was performed in group Ⅲ.postoperative VAS and moving changes of respiratory function parameters were monitered.Result:(1)Effectual analgesia occurred in group Ⅰ and group Ⅱ,and they had a lower VAS than group Ⅲ(2) Patients in group Ⅰ and group Ⅱ had greaterVT,MV,VC,FVC,FEV1 and MVV than those of group Ⅲ Shallow monotonous breathing occurred in group Ⅲ(3)The value of mean PaO2 and SaO2 were lower in all patients and could not recover to the preoperative value in the first seven days after operation.Oxygenation was satisfactory in patients of group Ⅰ and group Ⅱ,PaO2 and SaO2 were higher (P<0.01) and A-aDO2was smaller (P<0.01) in group Ⅰ and group Ⅱthan those of groupⅢ,and the recovery was rapid.Conclusion:The improvement of respiratory function is significant and the recovery of pulmonary gas exchange fuction is rapid in patients receiving thoracic epidural analgesia after thoractomy.
关键词
术后镇痛
呼吸功能
剖胸手术
Postoperative analgesia Respiratory function Thoractomy
