全身麻醉联合区域神经阻滞在结直肠癌腹腔镜手术患者中的应用

Application of general anesthesia combined with regional nerve block in patients with colorectal cancer undergoing laparoscopic surgery

目的探讨全身麻醉联合区域神经阻滞在结直肠癌腹腔镜手术患者中的应用效果。方法系统性回顾2017年2~10月于我院普外科确诊并收入院拟行腹腔镜结直肠癌手术治疗的90例结直肠癌患者。根据麻醉方式不同分成A、B、C组,每组30例,A组行单纯全身麻醉,B组行全麻复合硬膜外阻滞,C组行全麻联合区域神经阻滞。记录三组患者术后的排气时间、卧床时间、住院时间和麻醉开始时、切皮时、缝合皮肤时的心率(HR)、平均动脉压(MAP)。记录并对比所有患者术后6、12、24 h的疼痛VAS评分。结果 C组患者的术后排气时间、卧床时间及住院时间均显著短于A、B组,差异有统计学意义(P<0.05)。C组患者切皮时与缝合皮肤时的HR、MAP均明显低于A、B组,差异有统计学意义(P<0.05);A、B组患者在切皮时、缝合皮肤时的HR、MAP显著高于麻醉开始时,差异有统计学意义(P<0.05);C组患者在缝合皮肤时的HR、MAP显著高于麻醉开始时,差异有统计学意义(P<0.05)。C组患者的术后6、12 h的VAS评分均明显低于A、B组,差异有统计学意义(P<0.05);三组患者的术后24 h的VAS评分较术后6 h评分显著降低,差异有统计学意义(P<0.05)。结论全身麻醉联合区域神经阻滞应用于结直肠癌腹腔镜手术患者能有效缩短患者术后恢复时间、减少应激反应、缓解手术疼痛,效果确切。

Objective To explore the application effect of general anesthesia combined with regional nerve block in patients with colorectal cancer undergoing laparoscopic surgery. Methods All of 90 patients with colorectal cancer scheduled for laparoscopic colorectal cancer surgery diagnosed and treated in department of general surgery of our hospital from February to October 2017 were systematically reviewed. Patients were divided into group A, B, C according to the different anesthesia methods, and there were 30 cases in each group. Group A received simple general anesthesia, group B received general anesthesia combined with epidural block, group C received general anesthesia combined with regional nerve block. The postoperative exhaust time, bed rest time, hospitalization stay, and heart rate（HR） and mean arterial pressure（MAP） at the beginning of anesthesia, during skin incision and skin closure in patients of the three groups were recorded, the postoperative pain score of 6, 12, 24 h were recorded and compared in all patients.Results The exhaust time, bed rest time and hospitalization stay of group C were significantly shorter than those of group A and group B, and the differences were statistical significant（P〈0.05）. HR and MAP in patients of group C during skin incision and skin closure were significantly lower than those in group A and group B, and the differences were statistical significant（P〈0.05）. Conclusion General anesthesia combined with regional nerve block applied in patients with colorectal cancer undergoing laparoscopic surgery can effectively shorten the postoperative recovery time, reduce stress response, relieve surgical pain, the effect is definite.