硬膜外麻醉复合全身麻醉对结直肠癌腹腔镜根治术患者血流动力学、组织氧合及麻醉药物剂量的影响

Effects of epidural anesthesia combined with general anesthesia on hemodynamics,tissue oxygenation and anesthetic dose in patients undergoing laparoscopic radical surgery for colorectal cancer

目的探讨硬膜外麻醉复合全身麻醉对结直肠癌腹腔镜根治术患者血流动力学、组织氧合及麻醉药物剂量的影响。方法选择行结直肠癌腹腔镜根治术治疗的88例患者,根据非随机临床同期对照研究及患者充分知情自愿原则分为观察组(硬膜外复合全身麻醉)和对照组(单纯全身麻醉),每组44例。观察和统计围术期各时点[入室后(T0)、气管插管后10 min(T1)、建立气腹后1 h(T2)、建立气腹后2 h(T3)、关闭气腹后10 min(T4)、拔管时(T5)]平均动脉压(MAP)和心率(HR)的变化,并于T0、T2、T3、T5时点进行动脉血气分析,记录脉搏血氧饱和度(SpO 2)和动脉血氧分压[p(O 2)],并计算肺内血分流率(QS/QT)。比较2组患者麻醉药物剂量、术后恢复情况及不良反应发生率。结果观察组T2、T3、T5时点MAP显著低于对照组,T2、T3时点HR显著低于对照组(P<0.05);观察组T2、T3、T5时点QS/QT显著低于对照组,SpO 2、p(O 2)显著高于对照组(P<0.05);观察组丙泊酚、瑞芬太尼、顺阿曲库铵麻醉药物剂量均显著少于对照组,苏醒时间、拔管时间均显著早于对照组(P<0.05);2组不良反应发生率比较差异无统计学意义(P>0.05)。结论在结直肠癌腹腔镜根治术中采用硬膜外麻醉复合全身麻醉可有效维持术中血流动力学稳定,改善组织氧合功能,减少麻醉药物剂量,促进患者恢复。

Objective To observe effects of epidural anesthesia combined with general anesthesia on hemodynamics,tissue oxygenation and anesthetic dose in patients undergoing laparoscopic radical surgery for colorectal cancer.Methods Eighty-eight patients who underwent laparoscopic radical surgery for colorectal cancer were enrolled.According to non-randomized clinical controled study and well-informed voluntary principle,they were divided into observation group(epidural anesthesia combined with general anesthesia)and control group(general anesthesia),with 44 cases in each group.Changes of mean arterial pressure(MAP)and heart rate(HR)after entering to the room(T0),at 10 min after tracheal intubation(T1),at 1 h after establishing pneumoperitoneum(T2),at 2 h after establishing pneumoperitoneum(T3),at 10 min after closing pneumoperitoneum(T4),at extubation time(T5)during perioperation were observed.At T0,T2,T3 and T5,arterial blood gas analysis was conducted.The pulse oximetric saturation(SpO 2)and arterial oxygen pressure[p(O 2)]were recorded,and intrapulmonary shunt ratio(QS/QT)was calculated.The anesthetic dose,postoperative recovery and incidence of adverse reactions were compared between the two groups.Results At T2,T3 and T5,the values of MAP in observation group were significantly lower,and HR at T2 and T3 was significantly lower than that in control group(P<0.05).At T2,T3 and T5,QS/QTin observation group was significantly lower,while SpO 2 and p(O 2)were significantly higher than those in control group(P<0.05).The doses of anaesthetic drugs such as propofol,remifentanil and cisatracurium in observation group were significantly less,and recovery time as well as extubation time were significantly earlier than those in control group(P<0.05).There was no significant difference in incidence of adverse reactions between the two groups(P>0.05).Conclusion The application of epidural anesthesia combined with general anesthesia in laparoscopic radical surgery for colorectal cancer can effectively maintain stability of intraoperative hemodynamics,improve tissue oxygenation function,reduce anesthetic dose,and promote patients′recovery.