腰硬联合麻醉复合全身麻醉在年龄>60岁右半结肠癌患者中的应用效果  

Effect of spinal-epidural anesthesia combined with general anesthesia for over 60 years old patients with right-sided colon cancer

作　　者：张拥军[1] 段志强[1] 王艳[1] Zhang Yongjun;Duan Zhiqiang;Wang Yan(Department of Surgical Anesthesiology,Bayannaoer City Hospital,Bayannaoer 015000,China)

机构地区：[1]内蒙古自治区巴彦淖尔市医院手术麻醉科,015000

出　　处：《国际医药卫生导报》2021年第19期3038-3041,共4页International Medicine and Health Guidance News

基　　金：2019年巴彦淖尔市医院院内科研项目(2019030)。

摘　　要：目的探究腰硬联合麻醉(spinal-epidural anesthesia,SEA)复合全身麻醉(general anesthesia,GA)在年龄>60岁右半结肠癌(RCC)患者中的应用效果。方法2016年1月至2020年6月,选取巴彦淖尔市医院178例年龄>60岁RCC患者进行前瞻性研究,按照随机数字表法分为研究组和常规组,各89例。研究组女40例,男49例,年龄(69.58±3.11)岁。常规组女41例,男48例,年龄(69.95±3.04)岁。两组均行腹腔镜下全系膜切除术,常规组采用GA,研究组在常规组的基础上加用SEA。比较两组术后苏醒时间、拔管时间,入室时(T_(0))、切皮时(T_(1))、气腹15 min(T_(2))、术毕(T_(3))血流动力学指标[心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)],术前、术后6 h、24 h免疫功能(CD3^(+)、CD4^(+)/CD8^(+)),不良反应发生率。结果研究组术后苏醒时间、拔管时间(6.47±1.13)min、(12.18±2.16)min,短于常规组的(11.06±1.82)min、(20.55±2.84)min(t=20.213、22.130,均P<0.05)。T_(1)、T_(2)时,研究组MAP[(95.09±7.12)mmHg(1 mmHg=0.133 kPa)、(89.89±7.32)mmHg]、HR[(76.83±4.52)次/min、(78.06±4.44)次/min]水平均低于常规组[(99.86±7.35)mmHg、(95.14±7.40)mmHg、(82.87±4.89)次/min、(85.45±5.08)次/min](t=4.398、4.758、8.557、10.333,均P<0.05)。术后6 h、24 h,研究组CD3^(+)[(58.92±2.94)%、(60.92±3.08)%]、CD4^(+)/CD8^(+)[(1.26±0.19)、(1.33±0.28)]水平高于常规组[(53.78±2.69)%、(58.29±2.92)%、(1.09±0.14)、(1.21±0.23)](t=12.169、5.846、6.795、3.124,均P<0.05)。研究组不良反应发生率6.74%(6/89),常规组7.87%(7/89)(χ^(2)=0.083,P=0.773)。结论SEA复合GA可显著降低对>60岁RCC患者机体免疫功能的影响,降低术中MAP、HR波动幅度,缩短术后苏醒及拔管时间,安全性较高。Objective To explore the effect of spinal-epidural anesthesia(SEA)combined with general anesthesia(GA)for over 60 years old patients with right-sided colon cancer(RCC).Methods From January 2016 to June 2020,one hundred and seventy-eight over 60 years old RCC patients treated at Bayannaoer City Hospital were selected for a prospective study,and were divided into a study group and a routine group by the random number table method,with 89 cases in each group.There were 40 females and 49 males in the study group,who were(69.58±3.11)years old.There were 41 females and 48 males in the conventional group,who were(69.95±3.04)years old.All the patients underwent laparoscopic total mesangial resection;GA was used in the routine group,and SEA was used in the study group on the basis of the routine group.The postoperative recovery times,extubation times,hemodynamic indicators[heart rate(HR)and mean arterial pressure(MAP)]when they entered the operation room(T_(0)),when their skin was incised(T_(1)),15 min after pneumoperitoneum(T_(2)),and after the operation(T_(3)),immune function(CD3^(+) and CD4^(+)/CD8^(+))before and 6 and 24 hours after the operation,and the incidences of adverse reactions were compared between these two groups.Results The postoperative wake-up time and extubation time were(6.47±1.13)min and(12.18±2.16)min in the study group,and were(11.06±1.82)min and(20.55±2.84)min in the routine group(t=20.213 and 22.130,both P<0.05).The MAP's and HR's at T_(1) and T_(2) were(95.09±7.12)mmHg(1 mmHg=0.133 kPa),(89.89±7.32)mmHg,(76.83±4.52)times/min,and(78.06±4.44)times/min in the study group,and were(99.86±7.35)mmHg,(95.14±7.40)mmHg,(82.87±4.89)times/min,and(85.45±5.08)times/min in the routine group(t=4.398,4.758,8.557,and 10.333,all P<0.05).The CD3^(+) and CD4^(+)/CD8^(+) 6 and 24 h after the operation were(58.92±2.94)%,(60.92±3.08)%,(1.26±0.19),and(1.33±0.28)in the study group,and were(53.78±2.69)%,(58.29±2.92)%,(1.09±0.14),and(1.21±0.23)in the routine group(t=12.169,5.846,6.795,and 3.124,all P<0

关 键 词：腰硬联合麻醉 全身麻醉 右半结肠癌 免疫功能 

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