瑞芬太尼联合硬膜外麻醉在近端胃癌手术中的应用效果

Efficacy of Remifentanil Combined with Epidural Anesthesia in Proximal Gastric Cancer Surgery

目的探讨瑞芬太尼+硬膜外麻醉应用于近端胃癌患者手术中对各时间点血压、心率(HR)及术后苏醒时间的影响。方法选取近端胃癌患者74例,按随机数字表法分为2组:对照组37例给予七氟烷+硬膜外麻醉,观察组37例给予瑞芬太尼+硬膜外麻醉,比较2组不同时间点{t0(给药前)、t1[双肺通气(TLV)10 min]、t2[单肺通气(OLV)40 min]、t3(OLV 1.5 h)、t4(再次TLV 20 min)}血压[舒张压(DBP)、收缩压(SBP)]及HR、不同时间点(术后1、4、12、24、48 h)视觉模拟评分(VAS)、术后苏醒时间及拔管时间。结果与对照组比较,观察组t0时DBP、SBP、HR差异无统计学意义(P>0.05),t1—t4时DBP、SBP及HR显著降低,术后1、4、12、24、48 h VAS评分显著降低,术后苏醒时间及拔管时间显著缩短,差异均有统计学意义(均P<0.05)。结论瑞芬太尼+硬膜外麻醉应用于近端胃癌患者,可有效调控血压、HR,减轻术后疼痛,促进患者术后苏醒。

Objective To investigate the effects of remifentanil+epidural anesthesia on blood pressure,heart rate(HR)and postoperative recovery time in patients undergoing proximal gastric cancer at different time points.Methods Seventy-four patients with proximal gastric cancer were randomly assigned to receive either sevoflurane+epidural anesthesia(control group,n=37)or remifentanil+epidural anesthesia(observation group,n=37).Diastolic blood pressure(DBP),systolic blood pressure(SBP)and HR were compared between the two groups before administration(t0),after bilateral lung ventilation(TLV)for 10 min(t1),afterone-lung ventilation(OLV)for 40 min(t2),after OLV for 1.5h(t3),and after second TLV for 20 min(t4).In addition,visual analogue scale(VAS)score,postoperative recovery time and extubation time were recorded1,4,12,24 and 48 h after operation.Results There were no significant differences in DBP,SBP and HR between the two groups at t0(P>0.05).Compared with the control group,the combination of remifentanil and epidural anesthesia decreased DBP,SBP and HR at t1-t4,reduced VAS scores at 1,4,12,24 and 48 h after operation,and shortened postoperative recovery time and extubation time(P<0.05).Conclusion Remifentanil combined with epidural anesthesia can effectively regulate blood pressure and heart rate,relieve postoperative pain,and promote postoperative recovery in patients with proximal gastric cancer.