镇痛方法对老年普胸患者术后早期谵妄的影响

摘要

目的 探讨镇痛对老年人普胸手术术后谵妄(POD)的影响.方法 普胸手术老年患者271例随机分为三组:A组,84例,硬膜外自控镇痛(PCEA);B组,99例,静脉自控镇痛(PCIA);C组,88例,分次肌肉注射镇痛药.比较术后48 h内的镇痛效果、谵妄发生率及心肺并发症的发生率.结果 A、B组术后镇痛效果均优于C组(P＜0.05);A组活动时疼痛轻于B组(P＜0.05).C组谵妄发生率为18.18％,显著高于A组的2.38％和B组的8.08％(P＜0.05).A组和B组心肺并发症的发生率分别为38.10％和47.47％,均显著低于C组的72.73％(P＜0.01).结论 与分次肌肉注射镇痛药比较,老年人普胸术后PCEA及PCIA镇痛效果较好,术后早期POD及心肺并发症发生率低.%Objective To investigate the impact of analgesia on early postoperative delirium (POD) in the elderly underwent thoracic surgery. Methods A total of 271 thoracic elderly patients was randomly divided into three groups of A (84 cases, treated with patient-controlled epidural analgesia) ,B(99 cases,treated with patient-controlled intravenous analgesia) and C(88 cases, treated with intramuscular analgesia). The efficacy of analgesia, the incidence rates of POD and postoperative complications were compared. Results The efficacy of analgesia was better in groups of A and B than that in group C(P<0. 05) .which of reducing movement pain was better in group A than that in group B(P<0. 05). The incidence of POD in group C was 18.18%,which was higher than 2. 38% in group A or 8. 08% in group B(P<0. 05). The incidence rates of cardiopulmonary complication in groups of A and B were 38.10% and 47.47%, which were lower than 72.73% in group C(P<0. 05). Conclusion Cpmpared to intramuscular analgesia, postoperative patient-controlled epidural or intravenous analgesia is better in providing analgesia and reducing the incidence rates of POD and postoperative cardiopulmonary complications in thoracic elderly patients.