全身麻醉联合硬膜外麻醉在直肠癌手术患者中的应用

Application of General Anesthesia Combined with Epidural Anesthesia in Patients With Rectal Cancer Opera-tion

目的:探究直肠癌手术中选择全身麻醉联合硬膜外麻醉的有效性。方法:将84例行直肠癌手术患者随机分为A组和B组,每组42例。A组患者采用全身麻醉联合硬膜外麻醉,B组患者采用全身麻醉,术后2周进行随访并对干预效果进行观察,记录2组患者手术情况、术后并发症以及患者手术不同时间段心率及平均动脉压水平,采用智力(MMSE)评分、认知(MoCA)评分对患者预后情况进行评估。结果:A组患者术后睁眼时间、术后呼吸恢复时间、术后拔管时间、术后应答时间均短于B组(P<0.05)。A组患者无术后并发症,B组患者发生8例,发生率为19.05%,2组比较差异有统计学意义(P<0.05)。麻醉前10min,2组患者心率及平均动脉压比较差异无统计学意义(P>0.05);插管时、切开后、拔管时,A组患者心率及平均动脉压均低于B组(P<0.05)。术前2组患者MMSE评分、MoCA评分比较差异无统计学意义(P>0.05),术后A组各评分均优于B组(P<0.05)。结论:全身麻醉联合硬膜外麻醉可以稳定直肠癌手术患者血流动力学状态,降低术后并发症发生率,促使患者术后恢复,值得临床推广应用。

Objective To explore the effectiveness of general anesthesia combined with epidural anesthe-sia in rectal cancer operation.Methods Total 84 patients with rectal cancer operation were randomly di-vided into group A and group B,with 42 cases in each group.Group A patients were treated with general anesthesia combined with epidural anesthesia,and group B patients were treated with general anesthesia.The patients were followed up for 2 weeks after operation and the intervention effect was observed.The operation situation,postoperative complications,heart rate and mean arterial pressure levels in different op-eration periods of patients in the two groups were recorded.The prognosis of patients was evaluated by in-telligence(MMSE)score and cognitive(MoCA)score.Results The postoperative eye opening time,postoperative respiratory recovery time,postoperative extubation time and postoperative response time of group A were shorter than those of group B(P<0.05).There was no postoperative complication in group A.In group B,total 8 patients had postoperative complications(19.05%).and the difference between the two groups was statistically significant(P<0.05).Ten minutes before anesthesia,there was no sig-nificant difference in heart rate and mean arterial pressure between the two groups(P>0.05).During in-tubation,incision,extubation,the heart rate and mean arterial pressure of group A were lower than those of group B(P<0.05).There was no significant difference in MMSE score and MoCA score between the two groups before operation(P>0.05).After operation,the scores of group A were better than those of group B(P<0.05).Conclusion General anesthesia combined with epidural anesthesia can stabilize the hemodynamic state of patients with rectal cancer operation,reduce the incidence of postoperative complica-tions,and promote postoperative recovery,which is worthy of clinical promotion and application.