全身麻醉复合硬膜外麻醉对肺癌手术患者的麻醉效果及术后肺部功能影响

Effects of general anesthesia combined with epidural anesthesia on anesthesia effect and postoperative lung function in patients undergoing lung cancer surgery

目的 探讨全身麻醉复合硬膜外麻醉对肺癌手术患者的麻醉效果及术后肺部功能影响。方法 选取2020年1月至2023年1月中国人民解放军总医院第六医学中心收治的200例肺癌患者为研究对象,采用随机数字表法分为对照组和观察组,每组100例。对照组给予全身麻醉,观察组给予全身麻醉复合硬膜外麻醉。比较分析两组患者术后麻醉苏醒情况和住院时间,术前以及术后24 h的免疫功能指标、炎症因子水平、肺功能,以及术后不良反应发生情况。结果 观察组患者术后的自主呼吸恢复时间、睁眼时间、拔管时间、麻醉恢复室停留时间、住院时间均短于对照组,差异均有统计学意义(P<0.05)。与术前比较,两组患者术后24 h的CD3+、CD4+、CD4+/CD8+均降低,且观察组高于对照组,差异均有统计学意义(P<0.05)。与术前比较,两组患者术后24 h的白介素-1、白介素-6、肿瘤坏死因子-α水平均升高,且观察组低于对照组,差异均有统计学意义(P<0.05)。与术前比较,两组患者术后24 h的残气量/总肺容量升高,每分钟最大自主通气量/第1秒用力呼气容积、(每分钟最大自主通气量-每分钟通气量)/第1秒用力呼气容积均降低,差异均有统计学意义(P<0.05);术后24 h,观察组患者的残气量/总肺容量低于对照组,每分钟最大自主通气量/第1秒用力呼气容积、(每分钟最大自主通气量-每分钟通气量)/第1秒用力呼气容积均高于对照组,差异均有统计学意义(P<0.05)。观察组患者的术后不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论 全身麻醉复合硬膜外麻醉可有效缩短肺癌患者的术后苏醒时间,减轻免疫功能抑制和炎症反应,显著改善患者的肺功能,且安全性较好。

Objective To investigate the anesthesia effect and postoperative lung function of general anesthesia combined with epidural anesthesia on patients undergoing lung cancer surgery.Method 200 patients with lung cancer admitted to the Sixth Medical Center,Chinese People’s Liberation Army General Hospital from January 2020 to January 2023 were selected as the study objects.They were divided into control group and observation group by random number table method,with 100 patients in each group.The control group was given general anesthesia,and the observation group was given general anesthesia combined with epidural anesthesia.Anesthesia recovery and hospital stay,immune function indexes,inflammatory factor levels,lung function before and 24 h after surgery,and postoperative adverse reactions were compared between the two groups.Result The postoperative recovery time of spontaneous respiration,eye opening time,extubation time,anesthesia recovery room stay time and hospital stay in observation group were shorter than those in control group,and the differences were significant(P<0.05).Compared with before surgery,CD3+,CD4+and CD4+/CD8+in two groups were decreased 24 h after surgery,and the observation group was higher than the control group,with significant differences(P<0.05).Compared with before surgery,the levels of IL-1,IL-6 and TNF-αin two groups were increased 24 h after surgery,and the observation group was lower than the control group,with significant differences(P<0.05).Compared with before surgery,RV/TLC in two groups was increased,and MVV/FEV1,(MVV-VE)/FEV1 were decreased 24 h after surgery,with significant differences(P<0.05).24 h after surgery,the RV/TLC of observation group was lower than that of control group,and MVV/FEV1,(MVV-VE)/FEV1 of observation group were higher than those of control group,with significant differences(P<0.05).The incidence of postoperative adverse reactions in observation group was lower than that in control group,and the difference was significant(P<0.05).Conclusion General anesthesia combined with epidural anesthesia can effectively shorten the postoperative recovery time of lung cancer patients,and reduce immune suppression and inflammatory response,and significantly improve the lung function of patients,with good safety.