神经阻滞复合全身麻醉在腹腔镜胃癌手术中的应用效果及对患者血清肿瘤标志物的影响

Effect of nerve block combined with general anesthesia in laparoscopic gastric cancer surgery and its influence on serum tumor marker

目的探讨神经阻滞复合全身麻醉在腹腔镜胃癌手术中的应用效果及对患者血清肿瘤标志物的影响。方法根据麻醉方式的不同将78例腹腔镜手术治疗的胃癌患者分为对照组和观察组,每组39例,对照组患者给予全身麻醉,观察组患者给予神经阻滞复合全身麻醉。比较两组患者生命体征[收缩压、舒张压、平均动脉压(MAP)、心率]及血流动力学指标[经皮动脉血氧饱和度(SpO2)],血清肿瘤标志物[糖类抗原125(CA125)、糖类抗原19-9(CA19-9)、癌胚抗原(CEA)]水平,麻醉期间丙泊酚、瑞芬太尼使用剂量,以及并发症发生情况。结果麻醉诱导后30 min、术后6 h,两组患者收缩压、舒张压、心率及MAP均低于本组麻醉诱导前,但观察组患者收缩压、舒张压、心率及MAP均高于对照组,差异均有统计学意义(P﹤0.05)。术后7天,两组患者CA125、CA19-9、CEA水平均低于本组手术前,差异均有统计学意义(P﹤0.05)。观察组患者瑞芬太尼、丙泊酚使用量均明显低于对照组,差异均有统计学意义(P﹤0.01)。观察组患者的并发症总发生率为5.13%,与对照组患者的10.26%比较,差异无统计学意义(P﹥0.05)。结论神经阻滞复合全身麻醉能改善胃癌腹腔镜手术患者的生命体征,降低血清肿瘤标志物水平,且不增加并发症发生风险。

Objective To investigate the effect of nerve block combined with general anesthesia in patients with lapa-roscopic gastric cancer surgery and its influence on serum tumor marker.Method A total of 78 gastric cancer patients treated with laparoscopic surgery were divided into control group and observation group according to the different anes-thesia methods,with 39 cases in each group.The patients in the control group were given general anesthesia,and the pa-tients in the observation group were given nerve block combined with general anesthesia.The vital signs[systolic blood pressure,diastolic blood pressure,mean arterial pressure(MAP),heart rate]and hemodynamic indicator[percutaneous ar-terial oxygen saturation(SpO2)],serum tumor markers[carbohydrate antigen 125(CA125),carbohydrate antigen 19-9(CA19-9),carcinoembryonic antigen(CEA)]levels,doses of propofol and remifentanil during anesthesia,and complica-tions were compared between the two groups.Result Thirty min after anesthesia induction and 6 h after operation,the systolic blood pressure,diastolic blood pressure,heart rate,and MAP of the two groups were lower than those before the induction,while the systolic blood pressure,diastolic blood pressure,heart rate,and MAP of the observation group were higher than those of the control group,and the differences were statistically significant(P<0.05).Seven days after the op-eration,the levels of CA125,CA19-9,and CEA in the two groups were lower than those before the operation,and the dif-ferences were statistically significant(P<0.05).The dosages of remifentanil and propofol in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.01).The total in-cidence of complications in the observation group was 5.13%,compared with 10.26%in the control group,the difference was not statistically significant(P>0.05).Conclusion Nerve block combined with general anesthesia can improve the vi-tal signs of patients with gastric cancer undergoing laparoscopic surgery,reduce the levels of serum tumor markers,and do not increase the risk of complications.