全身麻醉联合区域神经阻滞在结直肠癌腹腔镜手术患者中的应用
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摘要
目的探讨全身麻醉联合区域神经阻滞在结直肠癌腹腔镜手术患者中的应用效果。方法系统性回顾2017年2~10月于我院普外科确诊并收入院拟行腹腔镜结直肠癌手术治疗的90例结直肠癌患者。根据麻醉方式不同分成A、B、C组,每组30例,A组行单纯全身麻醉,B组行全麻复合硬膜外阻滞,C组行全麻联合区域神经阻滞。记录三组患者术后的排气时间、卧床时间、住院时间和麻醉开始时、切皮时、缝合皮肤时的心率(HR)、平均动脉压(MAP)。记录并对比所有患者术后6、12、24 h的疼痛VAS评分。结果 C组患者的术后排气时间、卧床时间及住院时间均显著短于A、B组,差异有统计学意义(P<0.05)。C组患者切皮时与缝合皮肤时的HR、MAP均明显低于A、B组,差异有统计学意义(P<0.05);A、B组患者在切皮时、缝合皮肤时的HR、MAP显著高于麻醉开始时,差异有统计学意义(P<0.05);C组患者在缝合皮肤时的HR、MAP显著高于麻醉开始时,差异有统计学意义(P<0.05)。C组患者的术后6、12 h的VAS评分均明显低于A、B组,差异有统计学意义(P<0.05);三组患者的术后24 h的VAS评分较术后6 h评分显著降低,差异有统计学意义(P<0.05)。结论全身麻醉联合区域神经阻滞应用于结直肠癌腹腔镜手术患者能有效缩短患者术后恢复时间、减少应激反应、缓解手术疼痛,效果确切。
Objective To explore the application effect of general anesthesia combined with regional nerve block in patients with colorectal cancer undergoing laparoscopic surgery. Methods All of 90 patients with colorectal cancer scheduled for laparoscopic colorectal cancer surgery diagnosed and treated in department of general surgery of our hospital from February to October 2017 were systematically reviewed. Patients were divided into group A, B, C according to the different anesthesia methods, and there were 30 cases in each group. Group A received simple general anesthesia, group B received general anesthesia combined with epidural block, group C received general anesthesia combined with regional nerve block. The postoperative exhaust time, bed rest time, hospitalization stay, and heart rate(HR) and mean arterial pressure(MAP) at the beginning of anesthesia, during skin incision and skin closure in patients of the three groups were recorded, the postoperative pain score of 6, 12, 24 h were recorded and compared in all patients.Results The exhaust time, bed rest time and hospitalization stay of group C were significantly shorter than those of group A and group B, and the differences were statistical significant(P<0.05). HR and MAP in patients of group C during skin incision and skin closure were significantly lower than those in group A and group B, and the differences were statistical significant(P<0.05). Conclusion General anesthesia combined with regional nerve block applied in patients with colorectal cancer undergoing laparoscopic surgery can effectively shorten the postoperative recovery time, reduce stress response, relieve surgical pain, the effect is definite.
Objective To explore the application effect of general anesthesia combined with regional nerve block in patients with colorectal cancer undergoing laparoscopic surgery. Methods All of 90 patients with colorectal cancer scheduled for laparoscopic colorectal cancer surgery diagnosed and treated in department of general surgery of our hospital from February to October 2017 were systematically reviewed. Patients were divided into group A, B, C according to the different anesthesia methods, and there were 30 cases in each group. Group A received simple general anesthesia, group B received general anesthesia combined with epidural block, group C received general anesthesia combined with regional nerve block. The postoperative exhaust time, bed rest time, hospitalization stay, and heart rate(HR) and mean arterial pressure(MAP) at the beginning of anesthesia, during skin incision and skin closure in patients of the three groups were recorded, the postoperative pain score of 6, 12, 24 h were recorded and compared in all patients.Results The exhaust time, bed rest time and hospitalization stay of group C were significantly shorter than those of group A and group B, and the differences were statistical significant(P<0.05). HR and MAP in patients of group C during skin incision and skin closure were significantly lower than those in group A and group B, and the differences were statistical significant(P<0.05). Conclusion General anesthesia combined with regional nerve block applied in patients with colorectal cancer undergoing laparoscopic surgery can effectively shorten the postoperative recovery time, reduce stress response, relieve surgical pain, the effect is definite.
引文
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[10]邱伟箐,刘骅,沈志勇,等.区域神经阻滞麻醉下老年腹股沟疝腹膜前修补术日间手术模式的临床应用[J].国际外科学杂志,2016,43(3):174-177.
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[12]韩佳韫,陆念红,邵勃,等.超声引导下腹横肌平面阻滞对腹腔镜结肠癌手术患者应激反应及免疫功能的影响[J].江苏医药,2016,42(3):277-280.
[13]华玉思,高巨,欧晓峰,等.超声引导神经阻滞联合右美托咪定在小儿腹股沟区手术的应用[J].医学临床研究,2015,32(3):450-452.
[14]刘罡,张鹏,孙振,等.右美托咪定并低浓度罗哌卡因在腹腔镜结直肠癌根治术腹横肌平面阻滞术后镇痛的应用[J].浙江临床医学,2016,18(8):1524-1526.
[15]陈红生,徐兴国,曹苏,等.超声引导下改良腹横肌平面阻滞在胃癌根治术中的应用[J].中华临床医师杂志(电子版),2015,9(1):174-175.
[2]施美钦,林平联,林拳平.腹腔镜直肠癌经自然腔道标本取出(NOSE)术的手术配合及体会[J].中国卫生标准管理,2017,8(26):157-159.
[3]耿翔,钱峻,杨豪俊.腹腔镜结肠造瘘术和结肠内支架置入术在晚期结直肠肿瘤治疗中的价值[J].实用临床医药杂志,2017,21(21):122-123,125.
[4]国家卫生计生委医政医管局;中华医学会肿瘤学分会.中国结直肠癌诊疗规范(2015版)[J].中华胃肠外科杂志,2015,18(10):961-973.
[5]吴劲松,张弢.结肠直肠癌手术的快速康复外科[J].外科理论与实践,2017,22(6):535-537.
[6]张忠涛,郑民华,姚宏伟,等.直肠癌经肛全直肠系膜切除专家共识及手术操作指南(2017版)[J].中国实用外科杂志,2017,37(9):978-984.
[7]徐旭仲,苏尔瞻,余微萍,等.不同麻醉法对血浆肾素、血管紧张素Ⅱ、醛固酮、皮质醇水平的影响[J].中华麻醉学杂志,1995,15(12):546.
[8]温迎春,周康华,付朝文,等.老年结直肠癌患者腹腔镜手术不同麻醉方式的比较[J].深圳中西医结合杂志,2016,26(5):11-12.
[9]阳文杰,马想明,黄强,等.腹横肌平面阻滞对结直肠肿瘤患者术后快速康复的影响[J].浙江医学,2016,38(17):1433-1435,1438.
[10]邱伟箐,刘骅,沈志勇,等.区域神经阻滞麻醉下老年腹股沟疝腹膜前修补术日间手术模式的临床应用[J].国际外科学杂志,2016,43(3):174-177.
[11]裴继东,郑莉伟.不同麻醉方法对直肠癌患者腹腔镜术中、术后的影响[J].中国卫生标准管理,2017,8(26):128-129.
[12]韩佳韫,陆念红,邵勃,等.超声引导下腹横肌平面阻滞对腹腔镜结肠癌手术患者应激反应及免疫功能的影响[J].江苏医药,2016,42(3):277-280.
[13]华玉思,高巨,欧晓峰,等.超声引导神经阻滞联合右美托咪定在小儿腹股沟区手术的应用[J].医学临床研究,2015,32(3):450-452.
[14]刘罡,张鹏,孙振,等.右美托咪定并低浓度罗哌卡因在腹腔镜结直肠癌根治术腹横肌平面阻滞术后镇痛的应用[J].浙江临床医学,2016,18(8):1524-1526.
[15]陈红生,徐兴国,曹苏,等.超声引导下改良腹横肌平面阻滞在胃癌根治术中的应用[J].中华临床医师杂志(电子版),2015,9(1):174-175.