摘要
目的 比较不同麻醉镇痛方式对开放胃癌根治术患者快速康复的影响。 方法 全身麻醉下行开放胃癌根治术患者67例，采用随机数字表法分为3组：全身麻醉联合硬膜外镇痛组（EA 组，20例）、全身麻醉联合患者自控静脉镇痛（patient-controlled intravenous analgesia， PCIA）组（PCIA组，24例）、全身麻醉联合肋缘下腹横肌平面（subcostal transverse abdominis plane， STAP）阻滞组（STAP组，23例）。3组全身麻醉诱导、维持用药相同，EA组行硬膜外阻滞和硬膜外镇痛，PCIA组行静脉镇痛，STAP组行双侧STAP阻滞和静脉镇痛。记录七氟醚、舒芬太尼及血管活性药物用量，记录术后1 h（T1）、6 h（T2）、12 h（T3）、24 h（T4）、48 h（T5）、72 h（T6）VAS评分及哌替啶用量，记录肠道功能恢复时间、首次进食时间、首次下床时间、住院时间，观察不良事件的发生情况。结果 与PCIA组VAS评分［（3.8±2.0）、（4.7±1.8）、（6.5±1.7）分］比较，EA组和STAP组在T1［（2.3±1.2）、（3.1±2.3）分］、T2［（2.3±1.1）、（3.4±2.0）分］、T3［（2.8±1.1）、（3.6±2.0）分］时点VAS评分显著降低（P＜0.05），发生恶心呕吐、疲倦嗜睡和头晕的例数显著减少（P＜0.05）。与EA组比较，PCIA组、STAP组舒芬太尼和哌替啶用量显著增多，麻黄碱用量和低血压例数显著减少（P＜0.05）。STAP组、EA组、PCIA组两两比较，肠道功能恢复时间［（37±12）、（50±16）、（74±13） h］、首次进食时间［（47±10）、（61±15）、（89±11） h］、首次下床时间［（41±15）、（54±18）、（56±22） h］依次延长（P＜0.05）。3组住院时间差异无统计学意义（P＞0.05）。 结论 全身麻醉联合硬膜外阻滞或多点STAP阻滞对开放胃癌根治术患者术后快速康复有利，而全身麻醉联合PCIA效果较差、副作用较多、恢复时间较长。
Objective To investigate the effects of different analgesia regimens on fast recovery in patients following radical operation for gastric cancer. Methods A total of 67 gastric cancer patients subjected to radical operation were randomly divided into three groups, receiving epidural analgesia （EA group, n=20）, intravenous analgesia （PCIA group, n=24） and subcostal transverse abdominis plane block（STAP group, n=23）, respectively. The consumption of sevoflurane, sufentanil and vasoactive drugs during operation, VAS score at 1, 6, 12, 24, 48, 72 h after operation, and pethidine consumption after operation were recorded. Recovery of gastrointestinal function, first postoperative feeding time, ambulation time, duration of stay in hospital and the occurrence of adverse effects were compared among three groups. Results Compared with PCIA group（3.8±2.0, 4.7±1.8, 6.5±1.7）, EA group and STAP group have less VAS scores in T1 [（2.3±1.2）, （3.1±2.3）], T2 [（2.3±1.1）, （3.4±2.0）], T3 [（2.8±1.1）, （3.6±2.0）] respectively and less occurrence of nausea and vomiting, fatigue and dizziness（P〈0.05）. Compared with EA group, PCIA group and STAP group have more consumption of sufentanil, pethidine and less consumption of ephedrine and less occurrence of hypotension. Recovery time of gastrointestinal function [（37±12）, （50±16）, （74±13） h], first postoperative feeding time [（47±10）, （61±15）, （89±11） h], and ambulation time [（41±15）, （54±18）, （56±22） h] significantly differ among STAP group, EA group and PCIA group （P〈0.05）. There was no difference in length of hospital stay between three groups. Conclusions General anesthesia combined with epidural analgesia or with subcostal transverse abdominis plane block is beneficial for the fast-recovery of gastric cancer patients subjected to radical operation. General anesthesia combined with intravenous analgesia has less analgesia, more side effects and longer recovery time.
出处
《国际麻醉学与复苏杂志》
CAS
2017年第7期592-596,600,共6页
International Journal of Anesthesiology and Resuscitation
关键词
胃癌根治术
镇痛
肋缘下腹横肌平面阻滞
快速康复
Analgesia
Radical operation for gastric cancer
Subcostal transverse abdominis plane block
Fast recovery
