超低浓度罗哌卡因硬膜外阻滞复合全麻在老年直肠癌患者手术中的应用

Application of epidural block with an ultra-low concentration of ropivacaine combined with general anesthesia in operation for rectal cancer in elderly patients

目的探讨超低浓度罗哌卡因硬膜外阻滞复合全麻在老年直肠癌患者手术中的应用。方法择期行直肠癌手术老年患者60例,随机分为0.1%罗哌卡因组(Ⅰ组),0.375%罗哌卡因组(Ⅱ组),单纯全麻组(Ⅲ组)。Ⅰ组患者选择0.1%罗哌卡因硬膜外阻滞复合全麻,Ⅱ组患者选择0.375%罗哌卡因硬膜外阻滞复合全麻,Ⅲ组患者选择单纯全凭静脉麻醉。比较3组患者麻醉期间生命体征变化、术后镇痛评分、肌力评分、术后恢复时间、全麻药用量及不良反应情况。结果Ⅰ组在平均动脉压(MAP)、心率(HR)最大变化率方面均显著小于Ⅱ、Ⅲ组(均P<0.05);Ⅰ、Ⅱ组患者清醒后镇痛评分均明显低于Ⅲ组(均P<0.05);Ⅰ、Ⅲ组患者Bromage评分均明显低于Ⅱ组(均P<0.05);Ⅰ与Ⅱ组患者手术结束至清醒时间(呼之睁眼)、手术结束至拨管(脱机吸氧SPO2 >95%维持2 min)时间均显著小于Ⅲ组(均P<0.05);Ⅰ、Ⅲ组患者感觉运动恢复时间(Bromage<2分)均明显小于Ⅱ组(均P<0.05);Ⅰ、Ⅱ组全麻药用量明显均低于Ⅲ组(均P<0.05);Ⅰ、Ⅱ组不良反应发生率均为10.00%,明显低于Ⅲ组的65.00%(P<0.05)。结论超低浓度罗哌卡因硬膜外阻滞复合全麻应用于老年直肠癌患者手术中有较好的临床价值,更易维持老年患者的血流动力学稳定,缩短患者术后苏醒时间,减少术后不良反应发生率,加快术后下肢肌力恢复,可促进患者快速康复。

Objective To investigate the application of epidural block with an ultra-low concentration of ropivacaine combined with general anesthesia in operation for rectal cancer in elderly patients. Methods 60 elderly patients undergoing operation for rectal cancer were randomly divided into a 0.1% ropivacaine group(group I), a 0.375 % ropivacaine group(group Ⅱ), and a simple general anesthesia group(group Ⅲ). Group I took general anesthesia and epidural block with 0.1% ropivacaine, group Ⅱgeneral anesthesia and epidural block with 0.375 % ropivacaine, and group Ⅲ intravenous anesthesia. The changes of vital signs, postoperative analgesic score, muscle strength score, postoperative recovery time, and adverse reactions were compared among three groups. Results Group I had less change in MAP and heart rate than group Ⅱ and group Ⅲ(P < 0.05). The postoperative analgesic score was lower in group Ⅰ and group Ⅱ than in group Ⅲ. The Bromage score was lower in group Ⅰand group Ⅲ than in group Ⅱ(P < 0.05). The time from the end of the operation to when the patients came to and the time from the end of the operation to extubation were shorter in group Ⅰand group Ⅱ than in group Ⅲ(P < 0.05). The time for the recovery of sensory and motion was shorter in group Ⅰ and group Ⅲ than in group Ⅱ(P < 0.05). The dosage of anesthesia drug was lower in group Ⅰ and group Ⅱ than in group Ⅲ. The incidence of adverse reactions was 10.00% in group Ⅰ, 10.00% in groupⅡ, and 65.00% in group Ⅲ(P < 0.05). Conclusions The application of epidural block with an ultra-low concentration of ropivacaine combined with general anesthesia in operation for rectal cancer in elderly patients has clinical value, and can main the patients’ hemodynamic stability, shorten their postoperative recovery time, reduce postoperative adverse reactions, and promote the postoperative recovery of lower limb muscle strength and their rehabilitation.