全麻复合硬膜外麻醉对腹腔镜结肠癌根治术患者麻醉效果及相关指标的影响  

Effects of General Anesthesia Combined with Epidural Anesthesia on Anesthesia Effect and Related Indicators in Patients Undergoing Laparoscopic Radical Resection of Colon Cancer

作　　者：袁观然 许秋平[1] 刘艳[1] 李俊[1] 刘仁齐 YUAN Guan-ran;XU Qiu-ping;LIU Yan;LI Jun;LIU Ren-qi(Department of Anesthesiology,Puren Hospital Affiliated toWuhan University of Science and Technology,Wuhan,Hubei,430081,China)

机构地区：[1]武汉科技大学附属普仁医院麻醉科,湖北武汉430081

出　　处：《现代生物医学进展》2020年第11期2102-2105,共4页Progress in Modern Biomedicine

基　　金：湖北省科技支撑计划项目(201702-87);武汉市卫生局临床医学科研项目(WX12Q17)。

摘　　要：目的:探究腹腔镜结肠癌根治术患者采用全麻复合硬膜外麻醉的效果及对相关指标的影响。方法:选取120例于2016年9月到2018年10月期间在我院进行腹腔镜结肠癌根治术的患者,按随机数字表法分为对照组(n=60)和复合组(n=60),对照组采用全麻,复合组采用全麻复合硬膜外麻醉。观察两组患者的麻醉效果;记录两组患者麻醉诱导前(T0)、气腹前(T1)、气腹后15 min(T2)、气腹结束后(T3)和出室即刻(T4)的舒张压(DBP)、收缩压(SBP)和心率(HR)的变化;手术前、麻醉复苏前和术后1天的胰岛素抵抗指数(IR)、血糖水平(BS)、肾上腺素(AD)以及血清皮质醇(Cor)水平的变化;麻醉前、麻醉后2 h、术后1天和术后3天的CD3^+、CD4^+、CD4^+/CD8^+的水平变化。结果:复合组患者的麻醉诱导时间、自主呼吸恢复时间和苏醒时间明显短于对照组,麻醉维持时间明显长于对照组(P<0.05)。复合组患者在T2、T3、T4时间点的DBP、SBP和HR明显低于对照组(P<0.05)。麻醉复苏前和手术后1天,复合组患者的IR、BS、AD、Cor的水平明显低于对照组(P<0.05)。麻醉后2 h、术后1天和术后3天的CD3^+、CD4^+、CD4^+/CD8^+明显高于对照组(P<0.05)。结论:对腹腔镜结肠癌根治手术患者进行全麻符合硬膜外麻醉可以提高麻醉效果,减少对血流动力学的影响,减轻应激反应,减少对患者细胞免疫功能的影响。Objective:To investigate the effects of general anesthesia combined with epidural anesthesia on anesthesia effect and related indicators in patients undergoing laparoscopic radical resection of colon cancer.Methods:120 patients underwent laparoscopic radical resection of colon cancer in our hospital from September 2016 to October 2018 were selected,they were divided into control group(n=60)and composite group(n=60)according to random number table method.The control group underwent general anesthesia,and the composite group underwent general anesthesia combined with epidural anesthesia.The anesthetic effects of the two groups were observed;Changes of diastolic blood pressure(DBP),systolic blood pressure(SBP)and heart rate(HR)in the pre-anesthesia induction(T0),pre-pneumoperitoneum(T1),pneumoperitoneum 15 min(T2),after pneumoperitoneum(T3),and immediate outpatient(T4);Changes in insulin resistance(IR),blood sugar(BS),adrenaline(AD),and serum cortisol(Cor)levels before surgery,before anesthesia recovery,and 1 day after surgery;The levels of CD3^+,CD4^+,CD4^+/CD8^+were changed before anesthesia,2 hours after anesthesia,1 day after surgery,and 3 days after surgery.Results:The anesthesia induction time,spontaneous breathing recovery time and recovery time of the composite group were significantly shorter than the control group,and the anesthesia maintenance time was significantly longer than the control group(P<0.05).The DBP,SBP and HR of the patients in the composite group at the T2,T3 and T4 time points were significantly lower than those in the control group(P<0.05).Before anesthesia resuscitation and 1 day after the surgery,the levels of IR,BS,AD and Cor in the composite group were significantly lower than those in the control group(P<0.05).The levels of CD3^+,CD4^+,CD4^+/CD8^+were significantly higher than those in the control group 2 h after anesthesia,1 day after operation and 3 days after operation(P<0.05).Conclusion:General anesthesia combined with epidural anesthesia for patients undergoing laparoscopic radic

关 键 词：全麻 硬膜外麻醉 结肠癌 T淋巴细胞亚群 应激反应 血流动力学 

分 类 号：R614[医药卫生—麻醉学] R735.35[医药卫生—外科学]