全麻下快通道麻醉技术在早期乳腺癌手术中的应用

Application of fast-track anesthesia technique under general anesthesia during surgery for early-stage breast cancer

目的探讨全麻下快通道麻醉技术在早期乳腺癌患者手术中的应用价值。方法选取2020年1月至2021年1月间大连市妇女儿童医疗中心(集团)收治的择期行乳腺癌手术的80例患者,将其按照随机数表法分为研究组(40例,行硬膜外复合七氟醚吸入快通道麻醉)和对照组(40例,常规静吸复合全麻)。对比两组患者麻醉前(T0)、诱导插管后即刻(T1)、切皮时(T2)、手术结束时(T3)和气管拔管即刻(T4)5个时间点的平均动脉压(MAP)和心率(HR)。对比两组患者完全清醒时间、拔管时间及拔管后血氧饱和度(SPO;)差异,对比两组患者术中及术后24h各类麻醉药物用量,比较两组患者恶心呕吐、躁动等不良反应发生率。结果麻醉前及手术结束时两组MAP、HR组间比较,差异无统计学意义(P>0.05)。插管即刻、切皮时及拔管即刻,研究组患者的MAP和HR均低于对照组;研究组患者术后完全清醒时间、拔管时间均低于对照组;研究组患者术中瑞芬太尼、丙泊酚及维库溴铵用量低于对照组,术后24h内研究组患者舒芬太尼用量低于对照组;研究组患者的不良反应发生率低于对照组患者,差异均有统计学意义(均P<0.05)。结论对乳腺癌手术患者开展全麻下的快通道麻醉技术,能够显著稳定患者围术期血流动力学指标,加快患者围术期恢复,降低术中及术后各类麻醉药物用量,同时安全性值得肯定。

Objective To explore the application value of fast-track anesthesia technology under general anesthesia in the operation for early-stage breast cancer. Methods Eighty patients who underwent surgery for elective breast cancer at Dalian Women and Children’s Medical Center/Group were selected from January 2020 to January 2021. Using random number table method, they were divided into an experimental group(40 patients, fast-track anesthesia of combined epidural anesthesia and sevoflurane inhalation) and a control group(40 patients, conventional intravenous inhalation combined with general anesthesia). Mean arterial pressure(MAP) and heart rate(HR) were compared between the two groups at 5 time points before anesthesia(T0), immediately after induction of intubation(T1), skin incision(T2), end of operation(T3), and immediately after tracheal extubation(T4). Time to complete wake up from anesthesia, time to extubation and SPO;after extubation was compared between the two groups. Dosage of different types of anesthetic agents were compared between the two groups. The incidence of adverse reactions such as nausea, vomiting and restlessness were compared between the two groups. Results The difference in MAP and HR before anesthesia and at the end of the operation was not statistically significant between the two groups(P>0.05). MAP and HR were significantly lower in the experimental group than in the control group at T1, T2 and T4(all P<0.05). The dosage of remifentanil, propofol and vecuronium was lower in the experimental group than in the control group, and the dosage of sufentanil was lower in the experimental group than that in the control group within 24 h after operation(all P<0.05). The incidence of adverse reactions was significantly lower in the experimental group than in the control group(all P<0.05). Conclusion The fast-track anesthesia technique under general anesthesia during surgery for breast cancer can significantly stabilize perioperative hemodynamic indicators, speed up perioperative recovery and reduce various intraoperative and postoperative dosage of anesthetic agents with good safety.