全麻联合硬膜外麻醉对Ⅰa2-Ⅱa2期宫颈癌全切术麻醉效果及NO和P物质的影响

Effect of General Anesthesia Combined with Epidural Anesthesia on Totalanesthesia and NO and SP in Patients with Stage Ⅰa2-Ⅱa2 Cervical Cancer

目的比较静脉全麻复合小剂量罗哌卡因硬膜外阻滞和单纯全麻对Ⅰa2-Ⅱa2期宫颈癌根治术的麻醉效果及对NO和P物质的影响。方法选取我院2016年11月-2017年11月收治Ⅰa2-Ⅱa2期宫颈癌患者82例,随机均分为观察组和对照组,对照组行全身静脉麻醉,观察组行静脉全麻复合小剂量罗哌卡因硬膜外阻滞。比较两组患者术中生命体征、血清学指标和麻醉效果等指标。结果两组患者T1/T2时血清中NO和P物质水平差异显著(P<0.05);T0与T3时患者血清中NO、P物质水平比较无明显差异(P>0.05);观察组患者麻醉中丙泊酚用量为462±34 mg,对照组患者为863±57mg,差异显著(t=-23.058,P=0.000);观察组的术毕拔管时间(12.6±1.6 min)显著低于对照组(27.2±3.2 min)(t=-26.30,P=0.000);观察组麻醉评分为优的人数(28人)显著多于对照组(19人)(P<0.05);观察组肌松效果与术后认知功能改善情况显著优于对照组(P<0.05),不良反应发生率更低。结论静脉全麻复合小剂量罗哌卡因硬膜外阻滞在Ⅰa2-Ⅱa2期宫颈癌全切术中具有创伤小、可稳定血压和心率、术后不良反应发生率低、认知功能改善情况良好、肌松效果满意等优点,能降低外周血的NO和P物质水平,可作为宫颈癌术的首选麻醉方法。

Objective To compare anesthesia effect of total anesthesia and NO and SP in patients with Ⅰa2-Ⅱa2 cervical cancer under general anesthesia combined with ropivacaine combined with epidural block and simple general anesthesia.Methods Eighty-two patients with cervical cancer Ⅰa2-Ⅱa2 who were treated in our hospital from November 2016 to November2017 were divided into observation group（ 41 cases） and control group（ 41 cases） according to random number table. The control group received general anesthesiaandobservation group Ropivacaine epidural anesthesia combined with general anesthesia.Comparedwiththetwo groups of patients,intraoperative vital signs,serological indicators,anesthesia and other indicators. Results The level of NO and P in serum of two groups were significantly different at T1/T2（ P〈0.05）.There was no significant difference in serum NO and SP between T0 and T3（ P〈0.05）.In the observation group,the dosage of propofol was（ 462±34 mg） in anesthesia and（ 863±57 mg） in control group,with significant difference（ t =-23.058,P = 0.000）,the extubation time in the observation group（ 12.6±1.6 min） was significantly lower than that in the control group（ 27.2± 3.2 min）,（ t =-26.30,P = 0.000）. The number of excellent anesthesia scores in the observation group（ 28 persons） was significantly higher in the control group（ 19 persons）（ P〈0.05）.The muscle relaxant effect and postoperative cognitive function in the observation group were significantly better than those in the control group（ P〈0.05）,with a low incidence of adverse reactions. Conclusion Ropivacaine epidural anesthesia combined with general anesthesia in Ⅰa2-Ⅱa2 cervical cancer hastheadvantagesofless trauma,stable blood pressure and heart rate,postoperative adverse reaction rate is low,cognitive function improved in good condition,Satisfactory effect of muscle relaxation and so on,itcan reduce the level of NO and P in peripheral blood,soit can be used as the preferred method of anesthesiain Cervical cancer total excision.