快通道麻醉在结直肠肿瘤术后快速康复中的应用

目的 探讨快通道麻醉(fast-track anesthesia,FTA)应用于结直肠肿瘤患者术后快速康复(enhanced recovery after surgery,ERAS)中的可行性. 方法 将需手术治疗的104例择期结直肠肿瘤患者按随机数字表法分为传统对照组和快康观察组,每组52例.其中快康观察组按FTA方法进行麻醉,传统对照组按传统麻醉方法进行麻醉,观察并比较两组麻醉前(T0)、气管插管后5 min(T1)、切皮时(T2)、探查时(T3)、拔除气管导管后5 min(T4)的HR及MAP变化,观察患者全身麻醉药丙泊酚及肌松药维库溴铵的用量、术后苏醒时间、肛门排气时间、术后住院时间,统计术后并发症肺部感染和吻合口漏的发生率. 结果 快康观察组手术过程中HR、MAP波动较传统对照组较小(P＞0.05).快康观察组术中麻醉药物的用量明显比传统对照组要少[丙泊酚(287±26) mg比(414±36) mg;维库溴铵(13.6±2.5) mg比(15.8±2.3) mg] (P＜0.05),快康组患者术后苏醒时间[(14±4)min比(26±13) min]、肛门恢复排气时间[(26±13)h比(54±19)h]、术后住院时间[(5.6±1.3)d比(8.0±2.6)d]及肺部感染发生率(3.85％比9.62％)均小于传统对照组,差异有统计学意义(P＜0.05),两组吻合口漏发生率差异无统计学意义(P＞0.05). 结论 FTA贯穿整个围手术期,对促进患者ERAS起着重要作用.

The application of fast-track anesthesia in enhanced recovery after surgery of colorectal carcinoma

Objective To explore the feasibility of the fast-track anesthesia (FTA) in the enhanced recovery after surgery (ERAS) of colorectal carcinoma.Methods One hundred and four colorectal carcinoma patients which were randomly divided into the conventional control group (n=52) and the enhanced recovery group(n=52) were analyzed in the study.The FTA was performed in the enhanced recovery group and the traditional anesthesia was performed in the (c)onventional control group.The changes of HR and MAP were observed and compared in two groups before anesthesia (T0),5 min after tracheal intubation (T1),skin incision (T2),probing (T3) and 5 min after removal of tracheal intubation(T4).The dosage of propofol for general anesthesia and the dosage of muscle relaxant vecuronium,the required time from after operation to tracheal catheter removal,the anal exhaust time and the postoperative hospital stay were observed.The incidence rate of postoperative pulmonary complications of infection and anastomotic leakage was counted.Results The HR and the fluctuation of MAP in the enhanced recovery group were more stable than those of the conventional control group (P＞0.05).Besides,the general anesthetics in the enhanced recovery group was significantly less than that in the conventional control group [propofolum (287±26) mg vs (414±36) mg,vecuronium (13.6±2.5) mg vs (15.8±2.3) mg](P＜0.05),and the recovery time [(14±4) min vs (26±13) min],the time of anus exhaust[(26±13) h vs (54±19) h],the length of hospital stay[(5.6±1.3) d vs (8.0±2.6) d] and the incidence of pulmonary infection (3.85％ vs 9.62％) in the patients were less than those in the control group (P＜0.05).The results showed that no statistically significant difference was found between the anastomotic leakage rate of two groups (P＞0.05).Conclusions The FTA was performed through the entire perioperative period,and it played an important role in the ERAS of colorectal carcinoma.