硬膜外阻滞联合全麻与单纯全麻对结肠癌根治术患者认知功能、血流动力学及疼痛的影响比较

The dynamic changes of cognitive function in patients with colon cancer undergoing radical operation under epidural block combined with general anesthesia

目的观察硬膜外阻滞联合全麻对结肠癌根治术患者认知功能、血流动力学及疼痛的影响。方法纳入2012年3月至2016年9月本院收治的120例结肠癌根治术患者为研究对象,随机抽分为观察组及对照组,每组各60例。观察组行硬膜外阻滞联合全身麻醉,对照组行单纯全身麻醉。采用蒙特利尔认知评估量表(MoCA)对患者手术前后认知功能进行评定,比较两组术中多时点平均动脉压(MAP)、心率(HR)及术后VAS疼痛评分(Visual Analogue Score)。结果观察组术后认知功能障碍(Postoperative cognitive dysfunction,POCD)发生率和术后6 h、12 h、24 h及72 h VAS疼痛评分均显著低于对照组(均P<0.05)。观察组术中各时间点HR和MAP差异无统计学意义(P>0.05),对照组各时点HR和MAP差异有统计学意义(P<0.05)。结论与单纯全麻相比,硬膜外阻滞联合全麻用于结肠癌根治术中利于降低术后认知功能障碍发生率,能获得满意的止痛效果,更有利于维持血流动力学稳定。

Objective To study the dynamic changes of cognitive function in patients with colon cancer undergoing radical operation under epidural block combined withgeneral anesthesia. Methods 120 cases of patients with colon cancer were randomly divided into two groups, with 60 cases in each group. The treatment group received epidural block combined with general anesthesia, while the control group only received simple general anesthesia. The cognitive function was assessed by the Montreal Cognitive Assessmet（MoCA）.The perioperative mean arterial pressure, heart rate and VAS pain score were compared between the two groups, and the relationship between anesthesia and postoperative cognitive function was analyzed. Results The incidence rate of postoperative cognitive dysfunction（POCD） and the VAS pain scores in the treatment group at different time points were significantly lower than those in the control group（P〈0.05）, while the intraoperative heart rate and mean arterial pressure were comparable between groups（P〉0.05）.Conclusion The effect of epidural block combined with general anesthesia is satisfactory in the radical operation of colon cancer. Compared with simple general anesthesia, it maintains the stability of hemodynamics, which is important to improve cognitive function after operation.