无阿片药物全身麻醉联合胸段硬膜外麻醉与常规全麻在胃癌根治术中的应用对比  

Comparison of the Application of Opiate-free General Anesthesia Combined with Thoracic Epidural Anesthesia and Conventional General Anesthesia in Radical Gastrectomy

作　　者：郭培霞 张朔 张新科[1] 王铭[1] 周威[1] 龚青安 GUO Peixia;ZHANG Shuo;ZHANG Xinke(Nanyang Central Hospital,Nanyang,473000)

机构地区：[1]河南省南阳市中心医院,473000

出　　处：《实用癌症杂志》2024年第12期2055-2060,共6页The Practical Journal of Cancer

摘　　要：目的对比分析无阿片药物全身麻醉联合胸段硬膜外麻醉(TEA)与常规全麻在胃癌根治术中的应用效果。方法选取行胃癌根治术的92例患者作为研究对象,采用随机数表法分为研究组和对照组,各46例。2组均接受腹腔镜胃癌根治术,对照组采用常规全麻(舒芬太尼+丙泊酚+依托咪酯+罗库溴铵+咪达唑仑),研究组接受无阿片药物全身麻醉(丙泊酚+依托咪酯+罗库溴铵+咪达唑仑+罗哌卡因)联合TEA。比较2组围术期指标和插管1 min后(T_(0))、切皮后5 min(T_(1))、伤口缝合完毕(T_(2))、拔管时(T_(3))的心率(HR)、平均动脉压(MAP)、Ramsay评分、Prince-Henry评分和麻醉苏醒指标、术后胃肠恢复及不良反应发生率。结果研究组麻醉时间短于对照组,术中丙泊酚用量少于对照组(P<0.05)。研究组T_(1)、T_(2)、T_(3)时的HR和MAP与T_(0)时无显著差异(P>0.05);对照组T_(1)、T_(2)、T_(3)时的HR和MAP与T 0时差异显著(P<0.05);研究组T_(1)、T_(2)、T_(3)时的HR和MAP均低于对照组(P<0.05);研究组T_(1)、T_(2)、T_(3)时的Ramsay评分均高于对照组,Prince-Henry评分低于对照组(P<0.05)。研究组苏醒时间、拔管时间、首次肛门排气时间、首次下床活动时间和住院时间均短于对照组(P<0.05)。研究组术后总不良反应发生率为6.52%,显著低于对照组的21.74%(P<0.05)。结论与常规全麻比较,无阿片药物全身麻醉联合TEA可稳定胃癌根治术患者围术期血流动力学,提高镇静镇痛效果和麻醉苏醒质量,促进术后胃肠道功能恢复,安全性好。Objective To compare and analyze the effect of non-opioid general anesthesia combined with thoracic epidural anesthesia(TEA)and conventional general anesthesia in radical gastrectomy of gastric cancer.Methods A total of 92 patients who underwent radical gastrectomy were selected as the research objects,and were divided into the study group and the control group by random number table method,46 patients in each group.Both groups received laparoscopic radical gastrectomy.The control group received conventional general anesthesia(Sufentanil+propofol+etomidate+rocuronium bromide+midazolam),while the study group received opiate-free general anesthesia(propofol+etomidate+rocuronium bromide+midazolam+ropivacaine)combined with TEA.The perioperative indexes,heart rate(HR),mean arterial pressure(MAP),Ramsay score,Prince-Henry score and anesthesia recovery index,postoperative gastrointestinal recovery and incidence of adverse reactions were compared between the 2 groups after 1min of intubation(T_(0)),5min after cuticulation(T_(1)),wound suture completion(T_(2))and extubation(T_(3)).Results The anesthesia time of the study group was shorter than that of the control group,and the amount of propofol was less than that of the control group(P<0.05).HR and MAP at T_(1),T_(2)and T_(3)were not significantly different from those at T_(0)(P>0.05).HR and MAP of control group at T_(1),T_(2)and T_(3)were significantly different from those at T 0(P<0.05).HR and MAP of the study group at T_(1),T_(2)and T_(3)were lower than those of the control group(P<0.05).Ramsay score of the study group at T_(1),T_(2)and T_(3)was higher than that of the control group,Prince-Henry score was lower than that of the control group(P<0.05).The recovery time,extubation time,first anal exhaust time,first getting out of bed time and hospitalization time of the study group were shorter than those of the control group(P<0.05).The incidence of postoperative adverse reactions was 6.52%in the study group,which was significantly lower than 21.74%in the control group(

关 键 词：常规全麻 无阿片药物全身麻醉 胸段硬膜外麻醉 血流动力学 胃肠道功能 

分 类 号：R735.2[医药卫生—肿瘤]