全麻联合硬膜外麻醉在腹腔镜结直肠手术中的应用

General anesthesia combined with epidural anesthesia in laparoscopic colorectal surgery

目的通过前瞻、随机、双盲的方法比较全麻和全麻联合硬膜外麻醉对结直肠手术的影响。方法选取162例行腹腔镜结肠癌根治术患者,随机分为两组,全麻组(G组)术后采用舒芬太尼静脉自控镇痛,全麻联合硬膜外麻醉组(E组)术后采用硬膜外自控镇痛。麻醉前,术后1h,术后1d、2d检测血浆C反应蛋白。评估术后2h、12h、24h休息及咳嗽时的疼痛程度,记录吗啡用量、恶心及呕吐、胃肠道功能恢复和住院时间。结果两组患者基本特征无统计学差异(P>0.05),E组阿片类药物消耗量明显低于G组。E组术后C反应蛋白水平也低于G组。相比于G组,E组出现恶心及呕吐更少、术后疼痛程度更轻、肠道功能恢复更快、住院时间更短。结论全麻联合硬膜外麻醉可有效抑制腹腔镜结直肠手术应激状态、减少阿片类药物使用及促进恢复。

Objective To evaluate the effect between general anesthesia and general anesthesia combined with epidural anesthesia on colorectal cancer patients by prospective,randomized,double-blinded clinical trial. Methods162 patients with colorectal cancer scheduled for an elective colon resection were enrolled in this study.Patients were randomised into two groups to receive either general anesthesia（G group） or general anesthesia combined with epidural anesthesia（E group）.G group patients received continuous infusion of fentany via a patient-controlled analgesia（PCA） after operation.E group patients received a patient-controlled epidural analgesia（PECA） pump.C-reactive protein（CRP） was measured before anesthesia,1h,1d,2d after surgery.Pain was assessed at 2h,12 h and 24 h after surgery at rest and while coughing. Opioid use, postoperative nausea and vomiting,the time of resumption of gastrointestinal function and length of stay were also measured. Results No differences were observed in baseline patient characteristics,clinical variables between the two groups.Amount of opioid analgesics was significantly lower in the E group than the G group.The level of CRP were significantly lower in the E group than those in the G group after sugery.The E group resulted beneficial on the prevention of nausea and vomiting,lower pain scales,improvement recovery of bowel function, and shortened hospital stay than those in the G group. Conclusion General anesthesia combined with epidural anesthesia in the setting of laparoscopic colorectal surgery can efficiently restrain the stress response of operation,reduce dosage of opioid analgesics and improve early recovery.