硬脊膜外阻滞复合全麻对行胃癌根治术患者苏醒期躁动及POCD的影响

Effects of Epidural Block Combined with General Anesthesia on Aagitation and POCD During Recovery Period in Patients Undergoing Radical Gastrectomy for Gastric Cancer

目的 探讨硬脊膜外阻滞复合全麻对行胃癌根治术患者苏醒期躁动(EA)及认知功能障碍(POCD)的影响。方法 选择2020年2月至2022年1月于本院治疗的72例胃癌患者,按随机数字表法将其分为两组,各36例。两组患者均行胃癌根治术治疗,对照组采用全身麻醉,观察组采用全身麻醉复合硬脊膜外阻滞治疗。比较两组患者苏醒及拔管时间、镇痛效果、POCD及不良反应。结果 观察组苏醒时间为(10.79±3.41)min、拔管时间为(15.06±6.97)min,均短于对照组的(16.82±4.07)min、(20.49±7.14)min,视觉模拟评分法(VAS)评分为(3.12±1.07)分,低于对照组的(3.79±1.45)分,术后简易精神状态评价量表(MMSE)评分为(26.85±1.04)分,高于对照组的(25.41±0.93)分;POCD为5.56%、EA发生率为8.33%,低于对照组的22.22%、33.33%,差异均有统计学意义(P<0.05);两组恶心、头晕发生率比较,差异无统计学意义(P>0.05)。结论 硬脊膜外阻滞与全身麻醉复合用于胃癌根治术中患者苏醒快,可缩短拔管时间,降低EA及POCD发生率,增强镇痛效果,减轻对患者认知功能的影响。

Objective To investigate the effect of epidural block combined with general anesthesia on emergence agitation(EA) and cognitive dysfunction(POCD) in patients undergoing radical gastrectomy for gastric cancer.Methods A total of 72 patients with gastric cancer who were treated in our hospital from February 2020 to January 2022 were selected and divided into two groups according to the random number table method, with 36 cases in each group. Both groups were treated with radical operation for gastric cancer, the control group was treated with general anesthesia, and the observation group was treated with general anesthesia combined with epidural block. The recovery time and extubation time, analgesic effect, POCD and adverse reactions were compared between the two groups.Results The recovery time of the observation group was(10.79±3.41) min and the extubation time was(15.06±6.97)min, which were shorter than those of the control group(16.82±4.07)min and(20.49±7.14)min.Visual analogue scale(VAS) score was(3.12±1.07),which was lower than that of the control group(3.79±1.45),and the postoperative Mini Mental State Evaluation Scale(MMSE) score was(26.85±1.04), which was higher than that of the control group(25.41±0.93) points;POCD was 5.56%, and the incidence of EA was 8.33%, which was lower than 22.22% and 33.33% of the control group, and the differences were statistically significant(P<0.05). There was no difference in the incidence of nausea and dizziness between the two groups. Statistical significance(P>0.05).Conclusion The combination of epidural block and general anesthesia for patients with gastric cancer during radical gastrectomy can shorten the time of extubation, reduce the incidence of EA and POCD, enhance the analgesic effect, and reduce the impact on the cognitive function of patients.