超低浓度罗哌卡因硬膜外阻滞复合全麻在老年卵巢癌细胞减灭术中的应用  

Application of epidural block with an ultra-low concentration of ropivacaine combined with general anesthesia in ovarian cancer cytoreductive surgery in elderly patients

作　　者：曾莹吟 刘珊珊 刘理军 蔡铁良 胡宏强 Zeng Yingyin;Liu Shanshan;Liu Lijun;Cai Tieliang;Hu Hongqiang(Department of Anesthesiology,Chenggong Hospital Affiliated to Xiamen University,Xiamen 361002,China)

机构地区：[1]陆军第七十三集团军医院麻醉科,福建厦门361002

出　　处：《国际医药卫生导报》2021年第22期3500-3504,共5页International Medicine and Health Guidance News

基　　金：2018年厦门市医疗卫生项目(3502Z20189076)。

摘　　要：目的探讨超低浓度罗哌卡因硬膜外阻滞复合全身麻醉在老年卵巢癌细胞减灭术中的应用。方法选取2016年10月至2020年10月期间在陆军第七十三集团军医院行卵巢癌细胞减灭术的患者66例,根据不同麻醉方式分为Ⅰ组(25例)、Ⅱ组(21例)和Ⅲ组(20例)。Ⅰ组年龄(72.54±3.35)岁,Ⅱ组年龄(72.65±3.43)岁,Ⅲ组年龄(71.46±4.56)岁。Ⅰ、Ⅱ组为硬膜外阻滞复合全身麻醉的患者,对Ⅰ组注入0.100%罗哌卡因,对Ⅱ组注入0.375%罗哌卡因,Ⅲ组为单纯静脉麻醉患者。对比3组老年患者在术前、术中、术后的平均动脉压(MAP)、心率(HR)、肌力评定分数、苏醒时间、不良反应情况以及全身麻醉药用量的数据变化。结果在最大变化率上,Ⅰ组患者MAP、HR分别为(27.9±9.9)%、(24.8±8.1)%,均显著低于Ⅱ组(35.6±8.6)%、(27.5±9.1)%及Ⅲ组(43.9±12.3)%、(44.8±12.4)%,差异均有统计学意义(均P<0.05)。Ⅰ、Ⅱ组患者视觉模拟评分法(VAS)评分分别为(1.8±0.43)分、(1.5±0.36)分,均低于Ⅲ组(5.3±0.72)分,Ⅰ、Ⅲ组患者Bromage评分均明显低于Ⅱ组,差异均有统计学意义(均P<0.05)。Ⅰ、Ⅱ组患者不良反应发生率分别为8.00%(2/25)、14.28%(3/21),明显低于Ⅲ组60.00%(12/20),差异有统计学意义(P<0.05)。Ⅰ、Ⅱ组患者手术结束至清醒、手术结束至气管拔管时间与Ⅲ组比较,差异均有统计学意义(均P<0.05);Ⅰ、Ⅲ组患者手术结束至肌力恢复时间明显小于Ⅱ组,差异有统计学意义(P<0.05)。Ⅰ、Ⅱ组患者丙泊酚、瑞芬太尼、阿曲库铵用药量与Ⅲ组比较,差异均有统计学意义(均P<0.05);Ⅰ组患者丙泊酚、瑞芬太尼、阿曲库铵用药量与Ⅱ组比较,差异均无统计学意义(均P>0.05)。结论超低浓度罗哌卡因硬膜外阻滞复合全身麻醉在老年女性卵巢癌细胞减灭术中有良好的临床效应;在术中不仅更易维持老年患者的生命体征平稳,更有利于恢复术后患者的下肢肌力,促进患者Objective To investigate the application of epidural block with an ultra-low concentration of ropivacaine combined with general anesthesia in ovarian cancer cytoreductive surgery in elderly patients.Methods A total of 66 elderly patients who underwent ovarian cancer cytoreductive surgery in Chenggong Hospital Affiliated to Xiamen University from October 2016 to October 2020 were selected.According to the methods of anesthesia,they were divided into groupⅠ[25 cases,(72.54±3.35)years old],groupⅡ[21 cases,(72.65±3.43)years old],and groupⅢ[20 cases,(71.46±4.56)years old].GroupⅠunderwent epidural block with 0.100%ropivacaine combined with general anesthesia,groupⅡunderwent epidural block with 0.375%ropivacaine combined with general anesthesia,and groupⅢunderwent simple intravenous anesthesia.The changes of preoperative,intraoperative,and postoperative mean arterial pressure(MAP)and heart rate(HR),muscle strength assessment score,recovery time,adverse reactions,and general anesthesia drug dosage were compared among the 3 groups.Results The maximum change rates of MAP and HR of groupⅠ[(27.9±9.9)%and(24.8±8.1)%]were significantly smaller than those of groupⅡ[(35.6±8.6)%and(27.5±9.1)%]and groupⅢ[(43.9±12.3)%and(44.8±12.4)%](all P<0.05).The Visual Analogue Scale(VAS)scores of groupⅠand groupⅡwere(1.8±0.43)points and(1.5±0.36)points,respectively,which were lower than that of groupⅢ[(5.3±0.72)points],and the Bromage scores of groupⅠand groupⅢwere significantly lower than that of groupⅡ,with statistically significant differences(all P<0.05).The incidences of adverse reactions in groupⅠand groupⅡwere 8.00%(2/25)and 14.28%(3/21),respectively,which were significantly lower than that in groupⅢ[60.00%(12/20)],with a statistically significant difference(P<0.05).There were statistically significant differences in the time from the end of surgery to consciousness and from the end of surgery to tracheal extubation between groupⅠandⅡand groupⅢ(all P<0.05),and the time from operation

关 键 词：老年患者 卵巢癌 罗哌卡因 超低浓度 

分 类 号：R614[医药卫生—麻醉学] R737.31[医药卫生—外科学]