全身麻醉复合罗哌卡因硬膜外阻滞对中上段食管癌患者术后拔管时间及肺部感染发生率的影响

Effects of general anesthesia combined with ropivacaine epidural block on extubation time and incidence of pulmonary infection in patients with middle and upper section esophageal cancer after surgery

目的探讨全身麻醉复合罗哌卡因硬膜外阻滞在中上段食管癌患者手术中的应用效果。方法选取2017年10月~2019年10月某院中上段食管癌患者80例,按随机数字表法分研究组(n=40)、对照组(n=40)。均行颈胸腹三切口食管癌根治术治疗,对照组采用全身麻醉,研究组采用全身麻醉复合罗哌卡因硬膜外阻滞。比较两组麻醉前、插管时、拔管时血流动力学指标[平均动脉压(MAP)、心率(HR)]水平、术后拔管时间、术后不良事件(肺部感染、躁动)发生率。结果插管时、拔管时研究组MAP、HR均低于对照组(P<0.05);研究组术后拔管时间短于对照组(P<0.05);研究组术后不良事件发生率为2.50%(1/40),低于对照组20.00%(8/40)(P<0.05)。结论全身麻醉复合罗哌卡因硬膜外阻滞在中上段食管癌患者中的应用效果显著,可降低MAP、HR波动水平,缩短术后拔管时间,降低肺部感染、躁动发生率。

Objective To investigate the effect of general anesthesia combined with ropivacaine epidural block on patients with upper and middle section esophageal cancer after surgery.Methods From October 2017 to October 2019,80 patients with middle and upper section esophageal cancer in our hospital were selected,they were divided into study group(n=40)and control group(n=40)according to the random number table method.All patients underwent radical resection of esophageal cancer with three incisions of the neck,chest,and abdomen,the control group received general anesthesia,and the study group received general anesthesia combined with ropivacaine epidural block.The levels of hemodynamic indicators[mean arterial pressure(MAP),heart rate(HR)],postoperative extubation time,and incidence of adverse events(pulmonary infection,agitation)before anesthesia,during intubation and during extubation were compared between the two groups.Results The MAP and HR of the study group were lower than those of the control group at intubation and extubation(P<0.05);The postoperative extubation time in the study group was shorter than that in the control group(P<0.05);The incidence of postoperative adverse events in the study group was 2.50%(1/40),which was lower than the control group at 20.00%(8/40)(P<0.05).Conclusion The application of general anesthesia combined with ropivacaine epidural block in patients with middle and upper section esophageal cancer has a significant effect,it can reduce the MAP and HR fluctuation levels,shorten the extubation time,and reduce the incidence of lung infection and agitation.