硬膜外阻滞复合全身麻醉在老年原发性肝癌患者肝叶切除术中的应用价值分析  

Analysis of the application value of epidural block combined with general anesthesia in hepalobectomy of elderly patients with primary liver cancer

作　　者：江继端 蒋鹏飞[1] 杨帆[1] 刘虹[1] 罗丽[1] Jiang Jiduan;Jiang Pengfei;Yang Fan;Liu Hong;Luo Li(Department of Anesthesiology,Central Hospital of Suining City,Suining,Sichuan,629000,P.R.China)

机构地区：[1]四川省遂宁市中心医院麻醉科,四川遂宁629000

出　　处：《老年医学与保健》2021年第1期101-105,共5页Geriatrics & Health Care

基　　金：遂宁市中心医院科研项目(2019y45)。

摘　　要：目的研究硬膜外阻滞复合全身麻醉(epidural block combined with general anesthesia,GEA)在老年原发性肝癌(primary liver cancer,PHC)患者肝叶切除术中的应用价值。方法选择2018年7月-2020年6月于四川省遂宁市中心医院住院诊治的70例老年PHC患者,均在本院行肝叶切除术治疗,70例患者根据随机数字表法分为观察组(n=36)和对照组(n=34)。观察组患者给予GEA,对照组患者给予单纯全身麻醉。观察并比较2组患者血流动力学指标[平均动脉压(mean arterial pressure,MAP)、心率(heart Rate,HR)]、应激反应指标[血清皮质醇(cortisol,Cor)、内皮素(endothelin,ET)]、苏醒质量、麻醉药物用量和免疫功能(T淋巴细胞水平)等的变化情况。结果与麻醉前(TO)时点比较,2组气管插管后(T2)至拔管前(T4)时点的MAP、HR均显著升高,但观察组MAP、HR均明显低于对照组(P<0.05);与术前比较,2组术后Cor、ET水平均明显升高,但观察组上述指标水平明显低于对照组(P<0.05);观察组自主呼吸、拔管、麻醉后恢复室(post anesthesia care unit,PACU)停留时间和麻醉药物用量均明显少于对照组(P<0.05);与术前比较,2组术后4 h、24 h时免疫功能各项指标均明显降低,但观察组明显高于对照组(P<0.05)。结论对于行肝叶切除术的老年PHC患者,GEA有助于维持手术过程中血流动力学稳定,还有利于抑制患者的应激反应,对其术后苏醒和免疫功能恢复也可能具有积极作用。Objective To study the application value of epidural block combined with general anesthesia(EGA)in hepatectomy of elderly patients with primary liver cancer(PHC).Methods A total of 70 elderly patients with PHC who were hospitalized and treated with hepalobectomy in Central Hospital of Suining City between July 2018 and June 2020 were selected as the subjects.They were divided into observation group(36 cases)and control group(34 cases)by the random number table method.The observation group were given EGA,while the control group were given simple general anesthesia.Changes of hemodynamic indexes[mean arterial pressure(MAP),heart rate(HR)],stress response[serum cortisol(Cor),endothelin(ET)],recovery quality,narcotic dosage and immune function(levels of T lymphocytes)were compared between the two groups.Results Compared with pre-anesthesia(TO),MAP and HR of both groups increased significantly from the end of tracheal intubation(T2)to extubation(T4),but the MAP and HR of the observation group were significantly lower than those of the control group(P<0.05).Compared with before operation,the levels of Cor and ET of both groups were significantly increased after operation,but above indexes of the observation group were significantly lower than those of the control group(P<0.05).The spontaneous breathing recovery time,narcotic dosage,extubation time and post-anesthesia care unit(PACU)stay of the observation group were significantly less than those of the control group(P<0.05).Compared with before operation,the immune function indexes of the two groups decreased significantly at 4 h and 24 h after operation,but the immune function indexes of the observation group was significantly higher than those of the control group(P<0.05).Conclusion For elderly PHC patients undergoing hepalobectomy,EGA can help maintain hemodynamic stability during the operation,inhibit the stress response of patients,and may also have a positive effect on postoperative recovery and immune function recovery.

关 键 词：老年 原发性肝癌 肝叶切除术 硬膜外阻滞复合全身麻醉 

分 类 号：R614[医药卫生—麻醉学] R735.7[医药卫生—外科学]