丙泊酚硬膜外麻醉和复合全身麻醉在胃癌根治术患者中应用效果的比较

Comparison of the application effects of propofol epidural anesthesia and compound general anesthesia in patients undergoing radical gastrectomy

目的比较丙泊酚硬膜外麻醉和复合全身麻醉在胃癌根治术患者中的应用效果。方法依据麻醉方式的不同将132例胃癌根治术患者分为对照组(n=65,丙泊酚硬膜外麻醉)和观察组(n=67,丙泊酚复合全身麻醉),比较两组患者的手术指标[心率(HR)、平均动脉压(MAP)、脑氧代谢率(CMRO_(2))、脑血流量(CBF)、颅内压(ICP)]、围手术期麻醉指标、认知障碍[简易智力状态检查量表(MMSE)]和躁动情况[躁动行为量表(ABS)]及不良反应发生情况。结果麻醉后30min,观察组患者HR明显低于对照组,MAP、CMRO_(2)、CBF、ICP均明显高于对照组,差异均有统计学意义(P<0.01)。观察组患者的麻醉起效时间、完全阻滞时间、自主呼吸恢复时间和定向力恢复时间均明显短于对照组,差异均有统计学意义(P<0.01)。术后1、3、24h观察组患者MMSE评分均明显高于对照组,ABS评分均明显低于对照组,差异均有统计学意义(P<0.01)。观察组患者的不良反应总发生率为13.43%,低于对照组患者的29.23%,差异有统计学意义(P<0.05)。结论与丙泊酚硬膜外麻醉相比,丙泊酚复合全身麻醉应用于胃癌根治术患者中具有更好的麻醉效果和安全性,对患者中枢神经功能的影响较小,能减少患者术后认知障碍和躁动情况,促进患者术后快速恢复。

Objective To compare the application effects of propofol epidural anesthesia and compound general anesthesia in patients undergoing radical gastrectomy.Method A total of 132 patients with gastric cancer underwent radical gastrectomy were divided into control group(n=65,propofol epidural anesthesia)and observation group(n=67,propofol compound general anesthesia)according to different anesthesia methods.The surgical indexes[heart rate(HR),mean arterial pressure(MAP),cerebral metabolic rate of oxygen(CMRO_(2)),cerebral blood flow(CBF),intracranial pressure(ICP)],perioperative anesthesia indexes,cognitive disorder[mini-mental state examination(MMSE)],agitation condition[agitated behavior scale(ABS)],and incidence of adverse reactions were compared between the two groups.Result After 30 min of anesthesia,the HR in observation group was significantly lower than that in control group,and the MAP,CMRO_(2),CBF and ICP were significantly higher than those in control group,and the differences were statistically significant(P<0.01).The anesthesia onset time,complete block time,spontaneous respiration recovery time,and orientation recovery time in observation group were significantly shorter than those in control group,and the differences were statistically significant(P<0.01).At 1,3,24 h after operation,the MMSE scores in observation group were significantly higher than those in control group,the ABS scores were significantly lower than those in control group,and the differences were statistically significant(P<0.01).The total incidence of adverse reactions in observation group was 13.43%,which was lower than 29.23%in control group(P<0.05).Conclusion Compared with propofol epidural anesthesia,propofol compound general anesthesia has better anesthetic effect and safety in patients undergoing radical gastrectomy.It has less impact on central nervous function of patients,can reduce postoperative cognitive disorder and agitation condition of patients,and promote postoperative rapid recovery of patients.