老年病人腹部手术后镇痛剂量的探讨

目的：探讨静脉和硬膜外镇痛用于老年病人腹部手术后镇痛的剂量。方法：全麻腹部手术病人120例，年龄65-99岁，随机分六组；V1～V3组术毕经静脉自控镇痛，药液配方为每100ml生理盐水内含曲马多501）mg、芬太尼0．5mg、氟哌利多2．5mg；负荷量和背景量分别为V．组2ml、1．0ml／h，Ⅵ组3ml、1．5ml／h，U组4ml、1．5ml／h。E1～E3组硬膜外自控镇痛，药液为每100ml内含吗啡5mg、布比卡因100mg、氟哌利多2．5mg；负荷量和背景量分别为E1组2ml、1．0ml／h，E2组3ml、1．5ml／h，E3组4ml、1．5ml／h。PCA单次量2ml、锁定时间10min。记录2h、6h、12h、24h、48h疼痛、镇静和总舒适评分、镇痛用药量、PCA按压次数、有效按压率（D／D）及不良反应发生率。结果：镇痛用药量：V1组〉V2组，U组〉V1组，E3组〉B组，E3组〉E1组（均P〈0．05）。按压次数：E1组〉E3组，E1组〉B组（P％0．05），其余各组间无显著性差异。有效按压率（D／D）：静脉组中无显著差异，E1组〉E3组，E1组〉B组（均P％0．05）。疼痛评分：静脉组中无显著差异，E1组〉E3组，E1组〉R组（均P％0．05）。镇静评分：V1组〉V1组、V2组〉V1组（P〈0．05），硬膜外组中无显著差异。总舒适评分：E2组〉V1组（P〈0．05）。不良反应：恶心、呕吐V3组3次、B组4次，明显多于其他组；眩晕V3组4次；V1和V2组分别有4例和3例病人排气时问明显延长。结论：老年病人腹部手术后镇痛静脉组中，负荷量2ml、背景输注量1．0ml／h效果较佳。最适宜方式是吗啡硬膜外镇痛，剂量为：负荷量2～4ml、背景输注量1．2ml／h。

The Best Regimen of PCA in the Elderly Patients After Abdominal Operation

Objective: To find the best regimen of PCIA and PCEA in the elderly patients with abdominal operatioa Methods: 120 randomized patients undergoing elective abdominal surgeries, into 6 groups that received intravenous or epidural PCA with tramadol 500 mg, fentanyl0. 5mg and droperidol 2. 5 mg or epidural PCA with morphine 5 mg,bupivacaine 100mg and droperidol 2. 5 mg after operatioa Group V1 ,V2 and V3, were the intravenous groups and the loading doses were 2 ml,3 ml and 4ml, and continous infusion rate were 1. 0 ml/ h,1. 2 ml/h and 1. 5 ml/h respectively. Group E1 , E2 and E3 were the epidural groups. Their loading doses were 2 ml,3 ml and 4 ml and continous infusion rate were 1. 0 ml/h,1. 2 ml/h and 1. 5 ml/h respectively. Pain score, sedation score, total satisfaction score, analgesia solution consumption, PCA, demand/delivery(D/D) and adverse effect were recordeded for 48 hours. Results: Anesthetic consumption was in the following order: group V3>V1 , group V3>V2,group E3>E2, group E3>E1. Intra-group differences were statistically signifi-cant(F<0. 05). The pressing times: E1 >E3 ,E1 >E2 (P<0. 05). D/D of intravenous groups had no any significant differences. D/D of epidural groups was in the following order: E1 >E3, E1 >E2 (P<0. 05). Pain score of intravenous groups had no any significant differences. Pain score : E1 >E3, E1 >E2 (P<0. 05). Sedation score : V3>V1 ,V2>V1 (P<0. 05). Sedation score of epidural groups had no any significant differences. The total satisfaction score: E2>V1 (P<0. 05). The adverse effect : 3 and 4 patients felt nauseated or vomited in V3 and E3. 4 patients felt dizzy in V3. The bowel ventilation of 4 and 3 patients delayed in V3 and V2(P<0.05). Conclusion:Infusion at the rate of 1. 0 ml/h after a loading dose of 2 ml is likely a better regimen of tramadol PCIA in the elderly patients after abdominal operation. The best regimen of PCA was morphine PCEA at the rate of 1. 2 ml/h after a loading dose of 2-4 ml.