硬膜外阻滞复合全身麻醉对老年结直肠癌腹腔镜根治术患者血流动力学、肺内分流及氧合功能的影响

Effect of epidural block combined with general anesthesia on hemodynamics,intrapulmonary shunt and oxygenation function in elderly patients undergoing laparoscopic radical resection of colorectal cancer

目的探讨硬膜外阻滞复合全身麻醉对老年结直肠癌腹腔镜根治术患者血流动力学、肺内分流及氧合功能的影响。方法选取2018年6月至2020年6月期间郑州大学第二附属医院收治的128例老年结直肠癌腹腔镜根治术患者作为研究对象,利用随机数字表法分为2组,每组64例。对照组给予单纯全身麻醉,观察组给予硬膜外阻滞复合全身麻醉,对比2组患者血流动力学[入室后(T_(0))、气管插管后10 min(T_(1))、建立气腹后1 h(T_(2))、建立气腹后2 h(T_(3))、关闭气腹后10 min(T_(4))、拔管时(T_(5))时平均动脉压(MAP)和心率(HR)]、肺内分流[T_(0)、T_(2)、T_(3)、T_(5)时肺内血分流率(QS/QT)]、氧合功能[T_(0)、T_(2)、T_(3)、T_(5)时脉搏血氧饱和度(SpO_(2))和动脉血氧分压(PO_(2))]、麻醉质控指标(苏醒时间、拔管时间、麻醉药物剂量)以及并发症。结果观察组T_(1)~T_(5)时MAP、HR均低于对照组(MAP:t=7.063,P<0.001;t=16.907,P<0.001;t=15.533,P<0.001;t=9.982,P<0.001;t=3.990,P<0.001;HR:t=5.210,P<0.001;t=11.301,P<0.001;t=10.725,P<0.001;t=11.598,P<0.001;t=12.319,P<0.001)。观察组T_(2)、T_(3)、T_(5)时QS/QT均低于对照组(t=36.692,P<0.001;t=42.207,P<0.001;t=42.535,P<0.001)。观察组T_(2)、T_(3)、T_(5)时SpO_(2)、PO_(2)均高于对照组(SpO_(2):t=7.498,P<0.001;t=7.558,P<0.001;t=6.508,P<0.001;PO_(2):t=4.611,P<0.001;t=3.383,P<0.001;t=2.162,P<0.001)。观察组苏醒时间和拔管时间均短于对照组(t=5.395,P<0.001;t=7.763,P<0.001),丙泊酚和瑞芬太尼的用量少于对照组(t=9.970,P<0.001;t=6.661,P<0.001)。2组并发症发生率比较差异无统计学意义(χ^(2)=0.434,P=0.510)。结论硬膜外阻滞复合全身麻醉通过改善老年结直肠癌腹腔镜根治术患者交感神经兴奋性来稳定血流动力学,降低肺内分流,提高氧合功能,且不增加并发症。

Objective To explore the effects of epidural block combined with general anesthesia on hemodynamics,intrapulmonary shunt and oxygenation in elderly patients undergoing laparoscopic radical resection of colorectal cancer.Methods A total of 128 elderly patients undergoing laparoscopic radical resection of colorectal cancer in the Second Affiliated Hospital of Zhengzhou University from June 2018 to June 2020 were selected as the research objects,and they were divided into two groups by using a random number table method,each with 64 patients.The control group was given simple general anesthesia,and the observation group was given epidural block combined general anesthesia.The hemodynamics of the two groups were compared[after entering the room(T_(0)),10 minutes after tracheal intubation(T_(1)),1 h after establishing pneumoperitoneum(T_(2)),2 hours after the establishment of pneumoperitoneum(T_(3)),10 minutes after closing the pneumoperitoneum(T_(4)),changes in mean arterial pressure(MAP)and heart rate(HR)at the time of extubation(T_(5))],intrapulmonary shunt[intrapulmonary blood shunt rate(QS/QT)at T_(0),T_(2),T_(3),T_(5)],oxygenation function[pulse oxygen saturation(SpO_(2))at T_(0),T_(2),T_(3),T_(5),and arterial partial pressure of oxygen PO_(2)],Anesthesia quality control indicators(wake-up time,extubation time,dosage of anesthetic drugs)and complications.Results MAP and HR of the observation group were lower than those of the control group at T_(1)~T_(5)(MAP:t=7.063,P<0.001;t=16.907,P<0.001;t=15.533,P<0.001;t=9.982,P<0.001;t=3.990,P<0.001;HR:t=5.210,P<0.001;t=11.301,P<0.001;t=10.725,P<0.001;t=11.598,P<0.001;t=12.319,P<0.001).QS/QT of the observation group were lower than those of the control group at T_(2),T_(3),and T_(5)(t=36.692,P<0.001;t=42.207,P<0.001;t=42.535,P<0.001),and SpO_(2) and PO_(2) were both higher than those of the control group(SpO_(2):t=7.498,P<0.001;t=7.558,P<0.001;t=6.508,P<0.001;PO_(2):t=4.611,P<0.001;t=3.383,P<0.001;t=2.162,P<0.001).The recovery time and extubation time of the observation group were shorter than those of the control group(t=5.395,P<0.001;t=7.763,P<0.001),and the dosage of propofol and remifentanil was less than the control group(t=9.970,P<0.001;t=6.661,P<0.001).There was no significant difference in complications between the two groups(χ^(2)=0.434,P=0.510).Conclusion Epidural anesthesia combined with general anesthesia can stabilize hemodynamics,reduce intrapulmonary shunt,and improve oxygenation function without increasing complications by improving sympathetic nerve excitability in elderly patients undergoing laparoscopic radical resection of colorectal cancer.