全身麻醉联合硬膜外麻醉在腹腔镜直肠癌手术的应用  

General Anesthesia combined with Epidural Anesthesia in Laparoscopic Surgery for Colorectal Cancer

作　　者：曹德钧[1] 罗礼君[1] 

机构地区：[1]成都市第二人民医院麻醉科,四川成都610017

出　　处：《结直肠肛门外科》2015年第6期436-439,共4页Journal of Colorectal & Anal Surgery

摘　　要：目的探讨不同麻醉方法对腹腔镜直肠癌根治术患者的应激反应及血流动力学的影响。方法将64例择期行腹腔镜直肠癌根治手术的患者随机分为对照组(全身麻醉组)和观察组(全身麻醉联合硬膜外麻醉组)各32例,分别在麻醉前(T_0)、气腹后30min(T_1)、拔管后5 min(T_2)、拔管后2 h(T_3)采集静脉血测定血浆皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)水平,记录平均动脉压(MAP)及心率(HR)变化。结果对照组患者在T_1、T_2和T_3时血浆Cor、E、NE水平均较T_0时明显升高(P<0.05)。对照组患者T_1、T_2和T_3时血浆Cor、E、NE、MAP及HR水平明显高于观察组(P<0.05)。结论全身麻醉联合硬膜外麻醉可明显减轻腹腔镜直肠癌手术患者的应激反应,血流动力学更为稳定。Objective To explore the effects of different anesthesia methods for laparoscopic colorectal cancer resection on stress reaction and hemodynamics.Method Sixty-four patients undergoing laparoscopic colorectal cancer surgery were treated with general anesthesia or general anesthesia combined with epidural anesthesia.Plasma samples were collected to evaluate the levels of cortisol(Cor),epinephrine(E),norepinephrine(NE) in venous blood at before anesthesia(T0),30 min after aeroperitoneum(T1),5min after extubation(T2),and 2h after extubation(T3).Changes of mean arterial pressure(MAP) and heart rate(HR) were recorded.Results The levels of plasma Cor,E,and NE at T1,T2 and T3 were significantly increased compared with T0(P <0.05).The levels of plasma Cor,E,NE,MAP and HR in anesthesia group at T1,T2,and T3 were significantly higher than combined anesthesia group(P <0.05).Conclusion General anesthesia combined with epidural anesthesia for laparoscopic colorectal cancer surgery can reduce the stress response of patients and induce more stable hemodynamics.

关 键 词：全身麻醉 硬膜外麻醉 腹腔镜 直肠癌根治术 应激反应 血流动力学 

分 类 号：R614[医药卫生—麻醉学] R735.37[医药卫生—外科学]