高、低位硬膜外腔自控镇痛对术后呼吸、循环功能的影响

目的 比较高位硬膜外腔自控镇痛（ＰＣＥＡ）和低位ＰＣＥＡ对病人术后呼吸、循环功能的影响。方法 ３６例病人分为 两组，胸部手术１８例行高位ＰＣＥＡ（Ｈ组），下腹部手术１８例采用低位ＰＣＥＡ（Ｌ组）。术后均经硬膜外腔注入０．１２５％布 比卡因加０．０１％吗啡混合液行硬膜外自控镇痛。结果 两组病人组间对比呼吸频率、潮气量、肺活量、血氧饱和量（Ｒｒ、 Ｖｔ、ＶＣ、ＳｐＯ２）无显著差别；各组与启动自控镇痛前后比较Ｖｔ、ＶＣ改善明显（Ｐ<０．０１）。Ｈ组对血压和心率的影响较Ｌ组 明显（Ｐ＜０．０５）；启动ＰＣＡ泵前后比较，两组均有显著性差异（Ｐ<０．０１）。结论 高位ＰＣＥＡ对病人的循环影响较大，可能 与阻滞病人的心交感神经关系密切；ＰＣＥＡ能改善病人术后呼吸功能。无论高位还是低位ＰＣＥＡ均应根据实际镇痛的 个体情况及时调整ＰＣＡ泵的各项数据，以策安全。

Effects of patient-controlled upper and lower epidural analgesias on postoperative respiratory and circulatory function

Objective To compare the effects of patient-controlled high thoracic epidural analgesia (PCHEA) and low thoracic epidural analgesia (PCLEA) on respiratory and circulatory functions after operation. Methods Thirty-six patients were divided into 2 groups with 18 in each, and one group (Group H) received PCHEA during thoracic operations and the other (Group L) received PCLEA during abdominal operations. Postoperative patient-controlled analgesia (PCA) was performed in all the patients with 0.125% bupivacaine and 0.01% morphine delivered through the same epidural space for PCHEA or PCLEA. Results Postoperative analgesia did not produce significant differences in the respiration rate (Rr), tidal volume (Vt), vital capacity (VC) and oxygen saturation (Sp02) between the groups, but in both groups, Vt and VC were significantly improved compared with those before starting patient-controlled epidural analgesia (PECA) (P<0.01). In group H, its effects on systolic and diastolic blood pressure and heart rate were more obvious than in group L (P<0.05), and both groups showed these improvements after PCA started (P<0.01). Conclusion PCHEA shows more marked effects on the respiratory and circulatory functions of the patients, which may mainly result from its blocking the cardiac sympathetic nerves. PCEA is able to improve postoperative respiratory function but both PCHEA and PCLEA necessitate individual-based adjustment of the PCA pump for the safety of the patient.