摘要
目的探讨全麻复合硬膜外阻滞对腹腔镜下结肠癌根治术患者循环功能、血清S100β蛋白水平和认知功能的影响。方法选取60例腹腔镜下结肠癌根治术患者为研究对象,采用随机数字表法分为观察组和对照组,各30例。观察组患者予以全麻复合硬膜外阻滞,对照组患者予以全身麻醉。比较2组患者全麻诱导前(T1)、气管插管后(T2)、气腹建立后15 min(T3)、气腹结束后(T4)、拔管后5 min(T5)各时间点的平均动脉压(MAP)和心率(HR),比较麻醉前、术后2 h、24 h、48 h、72 h各时间点血清S100β蛋白水平,记录术后认知功能障碍(POCD)发生率和苏醒期情况。结果2组患者不同时间点MAP、HR比较均有统计学差异(P<0.05)。组间比较,观察组患者在T3时间点MAP、T5时间点HR均低于对照组,T4时间点MAP及T3、T4时间点HR均高于对照组(P<0.05)。观察组患者在术后2 h、24 h、48 h、72 h的血清S100β蛋白水平均低于对照组(P<0.05),术后24 h、48 h、72 h POCD发生率均低于对照组(P<0.05)。观察组患者苏醒时间、拔管时间均短于对照组,苏醒期躁动例数少于对照组(P<0.05)。结论腹腔镜下结肠癌根治术患者采取全麻复合硬膜外阻滞有利于术中血流动力学稳定,减轻神经功能损伤,减少POCD发生,并可提高苏醒期质量。
Objective To explore the effects of combined general epidural anesthesia on circulatory function,serum S100βprotein level and cognitive function in patients undergoing laparoscopic radical resection of colon cancer.Methods 60 patients undergoing laparoscopic radical resection of colon cancer were selected for the study and were divided into the observation group and the control group according to the random number table method,with 30 cases in each group.The observation group was given combined general epidural anesthesia,and the control group was given general anesthesia.The mean artery pressure(MAP)and heart rate(HR)were compared between the 2 groups before induction of general anesthesia(T1),after tracheal intubation(T2),at 15 min after establishment of pneumoperitoneum(T3),after the end of pneumoperitoneum(T4)and at 5 min after extubation(T5).Serum S100βprotein level was compared before anesthesia and at 2 h,24 h,48 h and 72 h after operation.The incidence rate of postoperative cognitive dysfunction(POCD)and recovery were recorded.Results There were statistically significant differences in MAP and HR between the 2 groups at different time points(P<0.05),and the MAP at T3 and HR at T5 in the observation group were lower than those of the control group,and the MAP at T4 and HR at T3 and T4 were higher than those of the control group(P<0.05).The serum S100βprotein level in the observation group was lower than that of the control group at 2 h,24 h,48 h and 72 h after operation(P<0.05),and the incidence rate of POCD at 24 h,48 h and 72 h after operation was lower than that of the control group(P<0.05).The recovery time and extubation time in the observation group were shorter than those of the control group,and the number of cases with agitation during recovery was less than that of the control group(P<0.05).Conclusion Combined general epidural anesthesia is beneficial to intraoperative hemodynamic stability in patients with laparoscopic radical resection of colon cancer,and it reduces neurological damage,reduces POCD,and improves the recovery quality.
作者
杨玲
张春梅
刘佳
温琰萍
张戈
YANG Ling;ZHANG Chunmei;LIU Jia(Guang’an People’s Hospital,Guang’an,638000)
出处
《实用癌症杂志》
2020年第5期833-836,共4页
The Practical Journal of Cancer
