快速康复外科理念在食管癌手术麻醉中的应用

目的: 探讨快速康复理念在食管癌手术麻醉中的应用价值。方法: 选取60例食管癌择期手术患者, 随机分为2组, 其中快速康复手术治疗组(观察组)30例, 采用全麻联合硬膜外阻滞实施手术, 应用限制性输液管理模式, 术中变温毯保温, 术后采用硬膜外镇痛泵;常规手术组(对照组)30例, 采用常规全麻实施手术, 术后采用常规静脉镇痛泵。比较2组患者麻醉前、手术切皮时、标本取出时及术毕时的血清皮质醇及血糖水平, 并观察术后拔管时间、肛门排气时间、住院时间及术后并发症情况。结果: 对照组患者手术切皮时、标本取出时和术毕各时点血糖及血清皮质醇水平均较麻醉前明显升高(P<0.01), 且均显著高于观察组患者各时点水平(P<0.01);观察组患者在手术切皮时、标本取出时及术毕时各时点血糖水平较麻醉前均无明显变化(P>0.05), 而血清皮质醇均较麻醉前明显升高(P<0.01);观察组患者术后拔管时间、肛门排气时间及住院时间均较对照组减少(P<0.05～P<0.01);2组并发症发生率差异无统计学意义(P>0.05)。结论: 快速康复理念在食管癌手术麻醉中的应用可促进患者早日康复。

Application of the fast tracksurgery concept in the anesthesia of esophageal cancer operation

Objective:To explore the application value of the fast tracksurgery(FTS) concept in the anesthesia of esophageal cancer operation. Methods:Sixty esophageal cancer patients scheduled by operation were randomly divided into the fast tracksurgery treatment group(observation group,30 cases),who were treated with combined general-epidural anesthesia surgery,the restrictive transfusion management,warming blanket insulation in operation and epidural analgesia pump after operation,and regular operation group( control group,30 cases) ,who were treated with the general anesthesia surgery and conventional intravenous analgesia pump after operation. The serum cortisol and blood glucose levels between two groups were detected and compared before anesthesia,and at the time of cutting the skin,taking out the specimen and the end of surgery. The extubation time, anal exhaust time, hospitalization time and incidence of postoperative complications in two groups were observed. Results:The blood glucose and serum cortisol levels in control group at the time of cutting the skin,taking out the specimen and the end of surgery were significantly higher than those of before anesthesia( P<0. 01),and each time-point of the observation group(P<0. 01). Compared with these of before anesthesia in observation group,the changes of the blood glucose levels at the time of cutting the skin,taking out the specimen and the end of surgery were no obvious ( P>0.05),and the serum cortisol levels significantly increased(P <0. 01). The postoperative extubation time,anal exhaust time and hospitalization time in observation group were less than those in control group(P<0. 05 to P<0. 01),the difference of the incidence of complication between two groups was not statistically significant(P >0. 05). Conclusions:The application of the fast tracksurgery concept in the anesthesia of esophageal cancer operation can promote the recovery of patients.