老年开胸患者术后不同镇痛方式的比较

目的：比较硬膜外自控镇痛（PCEA）、静脉自控镇痛（PCIA）和间断肌注镇痛三种方式用于老年患者开胸术后镇痛的效果及不良反应。方法：选择90例老年开胸手术病人，随机分为PCEA组（n=30）、PCIA组（n=30）和曲马多肌注组（n=30），分别记录患者VAS镇痛评分、镇静评分、不良反应及HR、MAP、SpO2值。结果：镇痛评分PCEA、PCIA组低于肌注组（P〈0．01），且PCEA组低于PCIA组（P〈0．01）；镇静评分PCEA、PCI-A组高于肌注组（P〈0．01），且PCIA组高于PCEA组（P〈0．01）；不良反应以PCEA组最低（P〈0．01）；HR、MAP、SpO2以PCEA组最平稳（P〈0．01）。结论：老年患者开胸术后3种镇痛方式中，肌注曲马多不能取得完善的镇痛效果，PCIA和PCEA镇痛效果满意，但PCEA优于PCIA。

Comparison of Different Methods of Postoperative Analgesia in Old Discharge-chest Surgical

Objective:To compare effects and stress response of patient-controlled epidural analgesia(PCEA)and patient-controlled intravenous analgesia(PCIA) and gap-infused analgesia (GTA) of postoperative analgesia in old discharge-chest surgical.Methods:90 patients undergoing old discharge-chest surgical were randomly divided into three groups,PCEA and PCIA and GTA 30 cases for each group.The datum were noted HR and MAP and SpO_2,analgesia-graded and calm-graded and stress response by visual analog scales(VAS).Results:Analgesia-graded in PCEA groups and PCIA groups were lower than GTA groups(P<0.01),PCEA groups was lower than PCIA groups;stress response in PCEA groups was lowest than PCIA groups and GTA groups(P<0.01);HR?MAP?SpO_2 in PCEA groups was lowest than PCIA groups and GTA groups(P<0.01).Conclusion:In three methods,infused tramadol can't complete analgesia,PCEA and PCIA are all effective for postoperative analgesia especially PCEA.