硬膜外麻醉复合全麻对结直肠癌手术患者组织氧合、麻醉用药剂量的影响分析

Analysis of the Effect of Epidural Anesthesia Combined with General Anesthesia on Tissue Oxygenation and Anesthetic Dose in Patients Undergoing Colorectal Cancer Surgery

目的:分析硬膜外麻醉复合全麻对结直肠癌手术患者组织氧合、麻醉用药剂量的影响。方法:选取淮安市金湖县中医院2021年5月—2022年6月收治的行结直肠癌根治术的80例患者作为研究对象,根据随机投掷法分为对照组和观察组,每组各40例。对照组行全麻方案,观察组行硬膜外麻醉复合全麻方案。比较两组患者围术期各时刻平均动脉压(MAP)、心率(HR)变化,比较两组患者各时刻动脉血氧分压(PO_(2))及血氧饱和度(SpO_(2)),比较两组患者麻醉药物剂量、麻醉恢复时间、应激反应发生情况及相关不良反应发生情况。结果:T_(1)、T_(2)、T_(3)时,两组患者HR增加,MAP升高,但观察组HR、MAP均低于对照组,两组患者SpO_(2)、PO_(2)均有所下降,但观察组SpO_(2)、PO_(2)均高于对照组,差异有统计学意义(t=15.601、18.278、12.239、5.005、4.958、4.651,P<0.05)。术后1 d,两组患者肾上腺素(NE)、血清皮质醇(Cor)水平均升高,但观察组NE、Cor水平均低于对照组,差异有统计学意义(t=5.129、7.769,P<0.05)。观察组丙泊酚、瑞芬太尼、顺阿曲库铵用药剂量均低于对照组,差异有统计学意义(t=5.306、6.957、4.978,P<0.05)。术后,观察组拔管时间、睁眼时间、自主呼吸恢复时间均短于对照组,差异有统计学意义(t=6.221、11.389、11.257,P<0.05)。术后,观察组出现低血压1例,恶心1例,发生率为5.00%;术后,对照组出现低血压1例,恶心1例,躁动1例,寒战1例,发生率为10.00%,两组患者比较,差异无统计学意义(χ^(2)=0.180,P>0.05)。结论:硬膜外麻醉复合全麻能够改善结直肠癌手术患者组织氧合功能,减少其术中血流动力学的异常波动和手术后应激反应的发生,能够减少麻醉药物剂量,患者麻醉后苏醒速度快,且未增加麻醉不良反应的发生率。

Objective:To analyze the effect of epidural anesthesia combined with general anesthesia on tissue oxygenation and anesthetic dose in patients undergoing colorectal cancer surgery.Methods:80 patients admitted to the hospital from May 2021 to June 2022 who underwent radical colorectal cancer were selected as the study subjects and divided into control group and observation group according to the random cast method,with 40 cases in each group.In the control group,a general anesthesia protocol was performed,and in the observation group,an epidural anesthesia combined with a general anesthesia protocol was performed.The changes of mean arterial pressure(MAP)and heart rate(HR)at each moment of the perioperative period,the partial pressure of arterial oxygen(PO_(2))and oxygen saturation(SpO_(2))at each moment of the perioperative period,the dose of anesthetic drugs,anesthesia recovery time,occurence of stress and the occurrence of related adverse reactions were compared between the two groups of patients.Results:At T1,T2 and T3,HR increased and MAP increased in both groups,but HR and MAP were lower in the observation group than in the control group,and SpO_(2)and PO_(2)decreased in both groups,but SpO_(2)and PO_(2)were higher in the observation group than in the control group,and the differences were statistically significant(t=15.601,18.278,12.239,5.005,4.958,4.651,P<0.05).At 1 d postoperatively,the NE and Cor levels increased in both groups,but the NE and Cor levels in the observation group were lower than those in the control group,and the difference was statistically significant(t=5.129,7.769,P<0.05).The doses of propofol,remifentanil,and cisatracurium administered in the observation group were lower than those in the control group,and the differences were statistically significant(t=5.306,6.957,4.978,P<0.05).After surgery,the time to extubation,time to eye opening,and time to recovery of spontaneous breathing were shorter in the observation group than in the control group,and the differences were statistically significant(t=6.221,11.389,11.257,P<0.05).After surgery,there was one case of hypotension and one case of nausea in the observation group,with an incidence of 5.00%,and one case of hypotension,one case of nausea,one case of agitation,and one case of chills in the control group,with an incidence of 10.00%.The difference in the incidence between the two groups was not statistically significant(χ^(2)=0.180,P>0.05).Conclusion:Epidural anesthesia compounded with general anesthesia can improve the tissue oxygenation function of colorectal cancer surgery patients,reduce their abnormal intraoperative hemodynamic fluctuations and the occurrence of postoperative stress reactions,and can reduce the dose of anesthetic drugs,and patients wake up quickly after anesthesia without increasing the occurrence of adverse anesthetic reactions.