小剂量较高浓度罗哌卡因持续硬膜外泵注复合全麻在老年患者胃癌手术中的应用  

Application of continuous epidural infusion of low-dose and high-concentration ropivacaine combined with general anesthesia in gastric cancer operation for the elderly

作　　者：高勤[1] GAO Qin(Department of Anesthesiology,the Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000)

机构地区：[1]川北医学院附属医院麻醉科,四川南充637000

出　　处：《赣南医学院学报》2019年第1期22-25,33,共5页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：目的:探究小剂量较高浓度罗哌卡因持续硬膜外泵注复合全麻在老年胃癌患者手术中的作用。方法:选取拟行胃癌手术老年患者180例,依据术前麻醉方式不同,分为复合组(n=100)、全麻组(n=80),复合组术前予以小剂量高浓度罗哌卡因持续硬膜外泵注复合全麻,全麻组术前单纯予以全身麻醉,观察两组患者苏醒时间、睁眼时间、拔管时间、吗啡用量、罗库溴铵用量、出室疼痛视觉模拟量表评分(VAS评分)、围术期心率(HR)、平均动脉压(MAP)、血清肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(COR)、血糖(BS)及术中肌肉松弛度评级。结果:复合组苏醒时间、睁眼时间、拔管时间、吗啡用量、罗库溴铵用量、VAS评分均低于全麻组(P<0.05);插管后(t_1)、术后(t_2)、拔管后(t_3)同时段复合组HR、MAP显著低于全麻组(P<0.05);t_1、t_2、t_3时刻较麻醉前(t_0)时刻,t_2较t_1和t_3时刻血液E、NE、COR、BS水平均升高(P<0.008),且同时段复合组显著低于全麻组(P<0.05);复合组与全麻组术中肌松优良率分别为93.00%、82.50%,复合组肌松优良程度显著高于全麻组(P<0.05)。结论:小剂量较高浓度罗哌卡因持续硬膜外泵注复合全麻对老年胃癌患者手术麻醉效果佳,安全性高。Objective:To investigate the effects of continuous epidural infusion of low-dose and high-concentration ropivacaine combined with general anesthesia in gastric cancer operation for the elderly.Methods:A total of 180 elderly patients who planed to be treated by gastric cancer operation were enrolled in the study.According to different preoperative anesthesia methods,the patients were divided into the combined group (n=100) and the general anesthesia group (n=80).Before operation,the combined group was given continuous epidural infusion of low-dose and high-concentration ropivacaine combined with general anesthesia while the general anesthesia group was given general anesthesia alone.The recovery time,eye-opening time,extubation time,dosage of morphine,dosage of rocuronium bromide,pain visual analogue scale score (VAS score),perioperative heart rate (HR),mean arterial pressure (MAP),serum adrenaline (E),norepinephrine (NE),cortisol (COR),blood sugar (BS) and grade of intraoperative muscle relaxation were observed.Results:The recovery time,eye-opening time,extubation time,dosage of morphine,dosage of rocuronium bromide and VAS score of the combined group were shorter/less than those of the general anesthesia group (P<0.05).The HR and MAP of the combined group were significantly higher than those of the general anesthesia group after intubation (t1),after operation (t2) and after extubation (t3)(P<0.05).The levels of blood E,NE,COR and BS at t1,t2 and t3 were higher at t1,t2,and t3 compared with before anesthesia (t0) and higher at t2 than t1 and t3 (P<0.008),and the levels in combined group were significantly lower than those in the general anesthesia group at the same time point (P<0.05).The excellent rate of muscle relaxation in the combined group was significantly higher than that in the general anesthesia group (93.00% vs 82.50%)(P<0.05).Conclusion:The anesthetic effect of continuous epidural infusion of low-dose and high-concentration ropivacaine combined with general anesthesia is good in gastric cancer operat

关 键 词：罗哌卡因 持续硬膜外泵注 全麻 老年患者 胃癌手术 

分 类 号：R971.2[医药卫生—药品]