不同镇痛方法对老年腔镜手术后二氧化碳残留的影响

目的观察不同镇痛方法对老年直肠腔镜手术后二氧化碳残留和苏醒质量的影响。方法选择择期在腹腔镜下辅助小切口老年直肠手术患者100例,随机分为两组:硬膜外自控镇痛(PCEA)组(A组)和连续伤口输注镇痛(CWIA)组(B组)。记录两组患者拔管时(T1)、拔管后1 h(T2)、2 h(T3)、6 h(T4)、12 h(T5)、24 h(T6)、48 h(T7)各时间点的PaCO2;T2~T7患者Steward苏醒评分、患者合作评分;苏醒时间、拔管时间、麻醉复苏室停留时间、镇痛泵自控情况、高碳酸血症相关并发症。结果A组患者T2~T5时间点的PaCO2比T1时增高(P<0.05),B组患者T2~T6时间点的PaCO2比T1时增高(P<0.05);在T2~T6各时间点组间比较,B组的PaCO2高于A组(P<0.05)。与A组比较,B组的苏醒时间、拔管时间、复苏室停留时间长于A组(P<0.05);两组镇痛泵自控情况比较差异无统计学意义(P>0.05)。术后高血压、烦躁、肩痛发生率B组高于A组(P<0.05);而恶心呕吐、低氧血症的发生率两组比较差异无统计学意义(P>0.05)。结论局麻药CWIA和PCEA具有相似的镇痛效果,但PCEA比CWIA的患者体内CO2残留较轻,苏醒时间短和苏醒质量较好,麻醉复苏期并发症发生率较低。

The Effects of Different Postoperative Analgesia Methods on Carbon Dioxide Retention After Laparoscopic Rectal Surgery in the Elderly

Objective To observe the effects of different postoperative analgesia methods on carbon dioxide retention and anesthesia recovery after laparoscopic rectal surgery in the elderly.Methods One hundred patients undergoing laparoscopic rectal surgery were randomly divided into two groups,Group A received patient controlled epidural analgesia(PCEA),and group B received continuous wound infusion(CWIA).PaCO2 values at the time of extubation(T1),1 hour(T2),2 hour(T3),6 hours(T4),12 hours(T5),24 hours(T6)and 24 hours(T7)after the extubation were recorded.Respectively,Steward scores,the scores of the patients'cooperation were assessed at the time points from T2 to T6.The awake time,extubation time,time of staying in the anesthesia recovery room,the total number of press PCA and effective compressions and the complications that were related to hypercapnia after extubation were compared between the two groups.Results PaCO2 values at T2~T5 in group A and T2~T6 in group B were increased compared with that at T1(P<0.05),and PaCO2 values of group B at T2~T6 were higher than those of group A(P<0.05).The patients'cooperation scores and the Steward scores of group B at T2~T4 were discreased than those of group A(P<0.05).The awake time,the extubation time and the time of staying in the anesthesia recovery room in group B were longer than that in group A(P<0.05).There were no differences in the total number of press PCA and effective compressions between the two groups(P>0.05).The incidences of hypertension,restlessness,restlessness in group B were higher than those in group A(P<0.05).There were no differences in the incidences of PONV,pruritus,hypoxemia between the two groups(P>0.05).Neither group had hypotension,arrhythmia,incisional infection and local hematoma affected wound healing.Conclusion The CWIA and PCEA have similar analgesic effect.However,The PCEA has less carbon dioxide retention,shorter awake time,better anesthesia recovery,lower incidence of complications during anesthesia recovery than the CWIA.