全麻复合硬膜外麻醉对胃癌根治术患者应激及炎性反应的影响

Effect of general anesthesia combined with epidural anesthesia on stress and inflammatory response in patients undergoing radical gastrectomy

目的分析全身麻醉(全麻)复合硬膜外麻醉对胃癌根治术患者应激及炎性反应的影响.方法94例实施胃癌根治术的患者作为研究对象,根据患者治疗顺序单双数的形式分为对照组及观察组,各47例.对照组实施全身麻醉(全麻),观察组实施全麻复合硬膜外麻醉.比较两组患者麻醉前、麻醉后0.5h、手术后2h的血流动力学指标[收缩压(SBP)、舒张压(DBP)、心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)]及应激反应指标[血浆皮质醇(COR)、血糖(GLU)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)].结果麻醉后0.5h及手术后2h,观察组患者的SBP、DBP、HR、MAP水平均低于对照组,SpO2水平高于对照组,差异均具有统计学意义(P<0.05).观察组患者麻醉后0.5h的COR、GLU、TNF-α、IL-6水平分别为(397.5±12.8)μg/L、(5.8±0.7)mmol/L、(1.8±0.4)μg/ml、(1.2±0.7)μg/ml,均低于对照组的(411.5±24.6)μg/L、(6.8±1.1)mmol/L、(3.1±1.1)μg/ml、(1.8±0.7)μg/ml,差异有统计学意义(P<0.05);观察组患者手术后2h的COR、GLU、TNF-α、IL-6水平分别为(390.2±12.1)μg/L、(5.7±1.3)mmol/L、(2.9±0.8)μg/ml、(1.8±0.8)μg/ml,均低于对照组的(401.2±21.2)μg/L、(6.5±1.2)mmol/L、(3.3±0.9)μg/ml、(3.3±1.4)μg/ml,差异均具有统计学意义(P<0.05).结论胃癌根治术患者采用全麻复合硬膜外麻醉效果良好,能够降低应激反应和炎性反应,有利于保证手术的安全性,可以在临床治疗中推广应用.

Objective To analyze the effect of general anesthesia combined with epidural anesthesia on stress and inflammatory response in patients undergoing radical gastrectomy. Methods A total of 94 patients undergoing radical gastrectomy as study subjects were divided by treatment order into control group and observation group, with 47 cases in each group. The control group received genera anesthesia, and the observation group received general anesthesia combined with epidural anesthesia. Comparison were made on hemodynamic parameters [systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR), mean arterial pressure(MAP), pulse oxygen saturation(SpO2)] and stress response indicators [plasma cortisol(COR), blood glucose(GLU),tumor necrosis factor-α(TNF-α), interleukin-6(IL-6)] before anesthesia and 0.5 h and 2 h after anesthesia between the two groups. Results At 0.5 h after anesthesia and 2 h after operation, the observation group had lower SBP, DBP, HR and MAP than the control group and higher SpO2 than the control group. Their difference was statistically significant(P<0.05). At 0.5 h after anesthesia, the observation group had lower COR, GLU,TNF-α and IL-6 respectively as(397.5±12.8) μg/L,(5.8±0.7) mmol/L,(1.8±0.4) μg/ml and(1.2±0.7) μg/ml than(411.5±24.6) μg/L,(6.8±1.1) mmol/L,(3.1±1.1) μg/ml and(1.8±0.7) μg/ml in the control group. The difference was statistically significant(P<0.05). At 2 h after operation, the observation group had lower COR,GLU, TNF-α and IL-6 respectively as(390.2±12.1) μg/L,(5.7±1.3) mmol/L,(2.9±0.8) μg/ml and(1.8±0.8) μg/ml than(401.2±21.2) μg/L,(6.5±1.2) mmol/L,(3.3±0.9) μg/ml and(3.3±1.4) μg/ml in the control group. Their difference was statistically significant(P<0.05). Conclusion General anesthesia combined with epidural anesthesia shows good anesthesia effect for patients undergoing radical gastrectomy. It can reduce the stress reaction and inflammatory reaction, and is conducive to ensuring the safety of surgery. It can be promoted and applied in clinical treatment.