硬膜外阻滞对老年患者开胸食管癌根治术的优势作用  

The advantages of continuous epidural block in elderly patients undergoing radical resection for esophageal cancer

作　　者：陈冬梅[1] 韩志强[1] 钟海燕[1] 范玲玲[1] 

机构地区：[1]内蒙古医科大学附属医院麻醉科,内蒙古呼和浩特010050

出　　处：《现代肿瘤医学》2016年第22期3642-3644,共3页Journal of Modern Oncology

基　　金：内蒙古医科大学青年创新基金项目(编号:YKD2015QNCX017)

摘　　要：目的：评价硬膜外阻滞对老年患者开胸食管癌根治术的优势作用。方法：择期拟在全麻下行开胸食管癌根治术老年患者80例,年龄≥65岁,体重50~90kg,性别不限,ASA分级I或Ⅱ级。采用随机数字表法分为4组（n=20）,分别行0.25%、0.20%、0.15%罗哌卡因硬膜外阻滞复合全麻组（E1-3组）和全麻组（G组）。记录全程血管活性药的种类及总量、瑞芬太尼（将术中舒芬太尼用量以1∶10等效转换成瑞芬太尼）及肌松药用量、清醒时间和出室时VAS评分。结果：E1和E2组血管活性药的用量多于G组（P〈0.05）,但瑞芬太尼用量明显少于G组（P〈0.05）,其余均与G组无差异（P〉0.05）。E2较E1血管活性药的用量明显减少（P〈0.05）,且瑞芬太尼用量差异无统计学意义;E1-3组清醒时间均短于G组（P〈0.05）;E1-3组组内比较清醒时间、肌松药用量差异无统计学意义。VAS评分E1、E2组低于E3和G组,E3与G组差异无统计学意义。结论：罗哌卡因硬膜外阻滞复合全麻对老年患者开胸食管癌根治术有明显的优势作用,表现在早苏醒、阿片类药物节俭,同时0.20%罗哌卡因浓度最能稳定血流动力学,是复合麻醉完成胸科手术的最适硬膜外用药浓度。Objective： To evaluate the advantages of continuous epidural block in elderly patients undergoing radical resection for esophageal cancer. Methods： Eighty patients,aged over 65,weighing 50 - 90 kg,ASA physical statusⅠ orⅡ,scheduled forradical resection for esophageal cancer,were randomly divided into 4 groups（ n = 20 in each） using a random number table： 0. 25%,0. 20%,0. 15% ropivacaine epidural block group（ group E1- 3） and general anesthesia group（ group G）. Vasoactive drug kinds and amount,consumption of remifentanil,sufentanil（ the consumption of sufentanil was converted to the the consumption of remifentanil producing the equivalent effect by 1∶ 10） and muscular relaxants,awake time,postoperative VAS score were recorded. Results： The dosage of vascular active drug in E1 and E2was more than group G（ P 〈0. 05）,but the dosage of remifentanil was less than group G（ P 〈0. 05）. The wake time in E1- 3was shorter than the group G（ P 〈0. 05）. The VAS score in E1 and E2was lower than the E3 and G,and there was no statistically significant difference in group E3 as compared with group G. Conclusion： The use of ropivacaine in epidural block has obvious advantages in elderly patients undergoing radical resection for esophageal cancer such as early awakening,opioids frugality. 0. 20% ropivacaine can stable hemodynamics. That is the optimum epidural drug concentration in combined anesthesia to complete thoracic surgery.

关 键 词：麻醉 硬膜外 老年人 食管肿瘤 食管切除术 优势作用 

分 类 号：R735.1[医药卫生—肿瘤]