全麻复合硬膜外麻醉对胃癌根治术患者术后疼痛程度的影响研究

Impact of Different Anesthesia Methods on Pain Degree of Stomach Neoplasm during Gastrectomy

目的观察胃癌根治术应用不同麻醉方式术后患者疼痛程度的影响。方法临床纳入实施胃癌根治术患者61例,根据术前麻醉方式的不同分为研究组与对照组。研究组进行全麻复合硬膜外麻醉,对照组进行单纯全麻。采用Prince-Henr评分比较两组患者术后6 h、12 h、18 h、24 h、48 h疼痛程度,术前、术中及术后分别比较两组患者血压情况、免疫抑制情况。结果研究组术后6 h、12 h、18 h、24 h、48 h Prince-Henr评分分别为(2.79±1.29)、(2.21±0.79)、(1.76±0.98)、(1.18±0.96)、(0.58±0.53)分,对照组术后6 h、12 h、18 h、24 h、48 h Prince-Henr评分分别为(3.73±2.02)、(3.43±1.87)、(2.97±1.18)、(2.39±1.42)、(1.20±0.87)分,差异均有显著性(P<0.05);研究组术中收缩压(SBP)、舒张压(DBP)分别为(109.25±10.45)mm Hg、(67.32±7.23)mm Hg,对照组术中SBP、DBP分别为(152.36±14.02)mm Hg、(92.44±18.91)mm Hg,差异均有显著性(P<0.05)。术前两组外周T淋巴细胞比较并无显著差异(P>0.05);术后研究组CD3+、CD4+、CD8+、CD4+/CD8+等指标基本恢复至诱导前水平,与对照组比较差异较为显著,P<0.05;术前两组自然杀伤细胞比例比较无差异,P>0.05;术毕两组患者自然杀伤细胞比例均显著下降,其中对照组低于研究组,P<0.05;术后5 d两组患者自然杀伤细胞水平有所上升,研究组程度更为显著,P<0.05。结论胃癌根治术前采用全麻复合硬膜外麻醉,能够显著缓解患者术后疼痛,此外术中有稳定血压的作用,缩短免疫抑制时间,值得推广。

Objective To study the impact of different anesthesia methods on pain degree of stomach neoplasm during gastrectomy. Methods 61 case of stomach neoplasm patients received gastrectomy were selected. The patients were divided into the study group and the control group, according to different preoperative anesthesia methods. The study group adopted the general anesthesia combined with epidural anesthesia. The control group adopted the general anesthesia. Through Prince-Henr points, the pain degree of the 2 groups 6h, 12h, 18h ,24h and 48h after treatment were compared. The blood pressure before, during and after treatment was compared. Results 6 h, 12 h, 18 h, 24 h and 48 h after treatment, Prince-Henr point of the study group were （2.79±1.29） ,（2.21±0.79）, （1.76±0.98） ,（1.18±0.96）, （0.58±0.53） ;Prince-Henr point of the control group were （3.73±2.02）, （3.43 ±1.87）, （2.97±1.18）, （2.39±1.42）, （ 1.20±0.87） （P 〈0.05） ;during treatment,SBP and DBP of the study group were（ 109.25±10.45 ） mmHg and （ 67.32±7.23 ） mmHg; SBP and DBP of the control group were （ 152.36±14.02） mmHg and（92.44±18.91 ） mmHg（ P 〈 0.05 ）. There was no significant difference in peripheral T lymphocytes between the 2 groups before and during the operation（P 〉 0.05） ;After the operation,the indexes of CD3 ＋ ,CD4 ＋ ,CD8 ＋ , CD4＋/CD8 ＋ and other indexes recovered to pre induction level, and the difference was more significant than that of the control group,P 〈 0.05 ; There was no difference in the pr＇oportion of natural killer cells between the 2 groups before surgery ; After surgery, the pro- portion of natural killer cells between the 2 groups significantly decreased, and the control group was lower than that of the study group;The level of natural killer cells of the 2 groups 5d after surgery increased,and the degree of the study group was more sig- nificant. Conclusion Before gastrectomy of stomach neoplasm, the general anesthesia combined with epidural anesthesia can greatly relieve the patient＇ s pain and stabilize blood pressure during treatment. It is worthy of promotion.