全身麻醉联合硬膜外阻滞对腹腔镜胃癌根治术患者POCD的影响

Analysis on the Effect of General Anesthesia Combined with Epidural Block on Post-operative Cognitive Disorder for Patients with Gastric Cancer Undergoing Laparoscopic Radical Operation

目的 探讨全身麻醉联合硬膜外阻滞对腹腔镜胃癌根治术患者术后认知功能障碍(POCD)的影响。方法 将62例行腹腔镜胃癌根治术的患者随机分成两组,分别采用单纯全身麻醉(对照组,n=31)、全身麻醉联合硬膜外阻滞(联合组,n=31)。比较两组的围术期相关指标、血流动力学及POCD的发生情况。结果 联合组丙泊酚用量较对照组明显减少(P<0.05);从T2时刻起,对照组HR水平较T_0时刻显著升高,MAP水平则显著降低(P<0.05),且联合组T_2、T_3、T_4时刻的MAP水平明显高于对照组(P<0.05)。术后1天,对照组MMSE评分较术前明显降低,且低于联合组(P<0.05);联合组POCD的发生率显著低于对照组(P<0.05)。结论 全身麻醉复合硬膜外阻滞用于腹腔镜胃癌根治术减少麻醉药物用量,维持血流动力学稳定,提高术后认知能力。

Objective To explore the effect of general anesthesia combined with epidural block for patients with gastric cancer undergoing laparoscopic radical operation. Methods Totally 62 patients with gastric cancer who received laparoscopic radical operation were randomly and equally divided into combined group（n = 31） and control group（n = 31）. Combined group and control group was given pure general anesthesia and general anesthesia combined with epidural block,respectively. The perioperative related indicators,hemodynamics and occurrence of POCD in both groups were compared. Results The dosage of propofol in combined group was significantly lower than that in control group（P〈0.05）. From T_2 moment,the HR was significantly increased,and MAP was reduced in control group compared with T_0 moment（P〈0.05）. The level of MAP in combined group was significantly higher than that in control group at T_2-T_4 moment（P〈0.05）. At 1 day after operation,MMSE score in control group was significantly reduced compared with before operation,and lower than combined group（P〈0.05）. The incidence of POCD in combined group was significantly lower than that in control group（P〈0.05）.Conclusion General anesthesia combined with epidural block for patients with gastric cancer undergoing laparoscopic radical operation can reduce the dosage of anesthetic drug,maintain hemodynamic stability,and improve postoperative cognitive ability.