全身麻醉复合罗哌卡因硬膜外阻滞麻醉对晚期胃癌患者术后VAS评分及肺功能影响分析

目的分析全身麻醉符合罗哌卡因硬膜外阻滞麻醉对晚期胃癌患者术后疼痛评分(VAS)及肺功能的影响。方法选取在我院行手术治疗的晚期胃癌患者80例为研究对象,按照手术顺序编号,单号设为对照组,双号设为观察组,各40例。两组患者均采用全身麻醉,观察组在对照组全麻基础上再予以罗哌卡因硬膜外阻滞麻醉。比较两组患者围麻醉期血流动力学指标(HR、SBP、MAP、SpO_(2))、术后2 h、4 h、6 h及24 h疼痛评分(VAS)变化,比较两组患者术前、术后24 h的肺功能指标(FEV1、FVC)。比较两组患者术后麻醉相关不良反应率。结果两组患者麻醉前HR、SBP、MAP、SpO_(2)组间差异均无统计学意义(P>0.05),插管后两组患者HR、SBP、MAP等均较麻醉前患者偏高,且观察组小于对照组(P<0.05),SpO_(2)较麻醉前偏低(P<0.05);术后24 h两组患者HR、SBP、MAP等均较麻醉前患者偏高,且观察组小于对照组(P<0.05),SpO_(2)较麻醉前偏低(P<0.05)。术后2 h、4 h、6 h及24 h观察组患者VAS评分均较低于对照组(P<0.05);术后24 h两组患者FEV1、FVC均较术前下降,但观察组下降幅度低于对照组(P<0.05);术后观察组患者麻醉相关不良反应率低于对照组(P<0.05)。结论全身麻醉复合罗哌卡因硬膜外阻滞麻醉方案对晚期胃癌手术患者术中血流动力学影响小,术后疼痛感受相对较轻、不良反应率更低,对术后肺功能影响小,利于患者术后康复,是适合晚期胃癌手术患者的麻醉方案。

Neoadjuvant plus adjuvant chemotherapy benefits overall survival of locally advanced gastric cancer

Neoadjuvant chemotherapy (NAC) has drawn more attention to the treatment of locally advanced gastric cancer (AGC) in the current multidisciplinary treatment model. EORTC trial 40954 has recently reported that NAC plus surgery without postoperative adjuvant chemotherapy could not benefit the locally AGC patients in their overall survival. We performed a meta-analysis of 10 studies including 1518 gastric cancer patients. Stratified subgroups were NAC plus surgery and NAC plus both surgery and adjuvant chemotherapy (AC), while control was surgery alone. The results showed that NAC plus surgery did not benefit the patients with locally AGC in their overall survival [odds ratio (OR) = 1.20, 95% CI 0.80-1.80, P = 0.37] and the number needed to treat (NNT) was 74. However, the NAC plus both surgery and AC had a slight overall survival benefit (OR = 1.33, 95% CI 1.03-1.71, P = 0.03) and NNT was 14, which is superior to the NAC plus surgery. Therefore, we recommend that combined NAC and AC should be used to improve the overall survival of the locally AGC patients.