全身麻醉联合硬膜外麻醉对腹腔镜直肠癌切除术患者血流动力学及临床效果分析

Analysis of hemodynamics and clinical effect of general anesthesia combined with epidural anesthesia on patients with laparoscopic rectal cancer resection

目的探讨全身麻醉联合硬膜外麻醉对腹腔镜直肠癌切除术患者血流动力学及临床效果的影响。方法选取2016年4月—2019年5月于辽宁省健康产业集团阜新矿总医院收治的行腹腔镜直肠癌切除术患者145例,依据术中麻醉方式不同分为联合组(75例,全身麻醉联合硬膜外麻醉)和单一组(70例,全身麻醉)。比较两组拔管时间、完全苏醒时间、血流动力学指标、苏醒后视觉模拟评分(VAS)、警觉/镇静评分(OAA/S)及并发症发生情况。结果整体分析发现:两组心电监护相关指标组间比较、时间点比较及交互作用差异均有统计学意义(P<0.05)。进一步两两比较,组内比较:两组建立气腹后1 h的心率(HR)快于麻醉前,平均动脉压(MAP)、呼气末二氧化碳分压(PETCO2)及气道压(Paw)均高于麻醉前(P<0.05);两组术后1 h的HR快于麻醉前,MAP及Paw均高于麻醉前(P<0.05)。组间比较:联合组建立气腹后1 h的HR慢于单一组,MAP、PETCO2及Paw均低于单一组(P<0.05);联合组术后1 h的HR慢于单一组,MAP及Paw均低于单一组(P<0.05)。联合组拔管时间、完全苏醒时间短于单一组,VAS低于单一组,OAA/S高于单一组,差异有统计学意义(P<0.05)。联合组术后并发症发生率低于单一组,差异有统计学意义(P<0.05)。结论全身麻醉联合硬膜外麻醉可使患者术中及术后血流动力学指标稳定,缩短患者拔管时间,患者苏醒后疼痛减轻,镇静效果好且不增加术后并发症,是腹腔镜直肠癌手术的一种有效麻醉方式。

Objective To explore the influence of hemodynamics and clinical effect of general anesthesia combined with epidural anesthesia on patients with laparoscopic rectal cancer resection.Methods From April 2016 to May 2019,145 patients undergoing laparoscopic rectal cancer resection in Fuxin General Hospital of Liaoning Health Industry Group were selected and divided into combined group(75 cases,general anesthesia combined with epidural anesthesia)and single group(70 cases,general anesthesia).The extubation time,complete recovery time,hemodynamic indexes,visual analogue scale(VAS),alertness/sedation score(OAA/S)and complications were compared between two groups.Results The overall analysis showed that there were significant differences in ECG monitoring related indicators between two groups,time point comparison and interaction(P<0.05).Further pairwise comparison,intra group comparison:one hours after pneumoperitoneum establishment,heart rate(HR)was faster than that before anesthesia,and mean arterial pressure(MAP),end expiratory CO2 partial pressure(PETCO2)and airway pressure(Paw)were higher than those before anesthesia in two groups(P<0.05).One hour after operation,HR was faster than that before anesthesia,MAP and Paw were higher than those before anesthesia in two groups(P<0.05).Comparison between two groups:one hours after pneumoperitoneum establishment,HR of combined group was slower than that of single group,MAP,PETCO2 and Paw of combined group were lower than those of single group(P<0.05).One hour after operation,HR of combined group was slower than that of single group,MAP and Paw of combined group were lower than those of single group(P<0.05).The extubation time and complete recovery time of combined group were shorter than those of single group,VAS of combined group was lower than that of single group,OAA/S of combined group was higher than that of single group,the differences were statistically significant(P<0.05).The incidence of postoperative complications in combined group was lower than that in single group(P<0.05).Conclusion General anesthesia combined with epidural anesthesia can stabilize the hemodynamic indexes during and after operation,shorten the time of extubation,relieve the pain after recovery,have good sedative effect and do not increase the postoperative complications.It is an effective anesthesia method for laparoscopic rectal cancer operation.