硬膜外阻滞复合全身麻醉在胸腔镜肺癌根治术中的应用效果

Application of epidural block combined with general anesthesia in thoracoscopic radical resection of lung cancer

目的分析硬膜外阻滞复合全身麻醉在胸腔镜肺癌根治术中的应用价值。方法抽取2019年7月至2020年8月于驻马店市中心医院行胸腔镜肺癌根治术患者86例,按随机数字表法分为A组与B组,每组43例。B组采用全身麻醉,A组采用硬膜外阻滞复合全身麻醉。比较两组麻醉优良率、视觉模拟评分法(VAS)评分、术后情况及不良反应发生率。比较两组麻醉前(T1)、切皮时(T2)、手术30 min(T3)、术毕即刻(T4)平均动脉压(MAP)、心率。结果A组麻醉优良率(97.67%,42/43)高于B组(81.40%,35/43),P<0.05。T2、T3时A组MAP、心率水平低于B组,且波动幅度小于B组(P<0.05)。A组自控按压药物次数少于B组,住院时间、拔除胸管时间短于B组(P<0.05)。术后6、48 h,A组VAS评分均低于B组(P均<0.05)。A组不良反应发生率(6.98%,3/43)与B组(9.30%,4/43)比较差异未见统计学意义(P>0.05)。结论硬膜外阻滞复合全身麻醉应用于胸腔镜肺癌根治术,可提高麻醉优良率,改善血流动力学,减少自控按压药物次数,可缓解疼痛,加快机体恢复,并具有麻醉安全性。

Objective To analyze the application vale of epidural block combined with general anesthesia in thoracoscopic radical resection of lung cancer.Methods A total of 86 patients undergoing thoracoscopic radical resection of lung cancer in Zhumadian Central Hospital from July 2019 to August 2020 were selected,and they were divided into group A and group B according to random number table method,with 43 cases in each group.Group B received general anesthesia,and group A received epidural block combined with general anesthesia.The excellent and good rates of anesthesia,visual analogue scale(VAS)score,postoperative condition and incidence of adverse reactions were compared between the two groups.The mean arterial pressure(MAP)and heart rate before anesthesia(T1),at skin incision(T2),30 min after the begin of operation(T3)and immediately after the operation(T4)were compared between the two groups.Results The excellent and good rate of anesthesia in group A was 97.67%(42/43),which was higher than the 81.40%(35/43)in group B(P<0.05).The levels of MAP and HR at T2 and T3 in group A were lower than those in group B,and the fluctuation range was smaller than that in group B(P<0.05).Compared with group B,group A had fewer self-controlled pressing times,shorter hospitalization time and chest tube removal time(P<0.05).The VAS score of group A was lower than that of group B at 6 and 48 h after operation(all P<0.05).There was no significant difference in the incidence of adverse reactions between group A(6.98%,3/43)and group B(9.30%,4/43),P>0.05.Conclusions Epidural block combined with general anesthesia in patients undergoing thoracoscopic radical resection of lung cancer can improve the excellent and good rate of anesthesia,improve hemodynamics,reduce the frequency of self-controlled pressing drugs,relieve pain,speed up recovery,with anesthesia safety.