快通道麻醉在老年结直肠肿瘤手术中的应用

目的探讨快通道麻醉用于老年结直肠肿瘤手术的临床效果。方法 92例老年结直肠肿瘤患者随机分为观察组（n=46）与对照组（n=46）,两组患者均给予腹腔镜手术治疗,观察组给予快通道静脉麻醉,对照组给予常规吸入麻醉,比较两组患者Steward麻醉苏醒评分及神经内分泌指标变化。结果观察组术后Steward≥4分者显著多于对照组（P〈0.01）,且术后拔管时间显著短于对照组（P〈0.01）;两组患者术前麻醉诱导前血浆皮质醇以及血糖浓度比较均差异无统计学意义（P〉0.05）,而麻醉开始后观察组患者在切皮后、手术结束时以及术后1 h血浆皮质醇及血糖均显著低于对照组（P〈0.05或P〈0.01）;观察组术后出现恶心、呕吐发生率显著低于对照组（P〈0.01）。结论快通道麻醉能够使患者获得较快的术后苏醒,同时降低了麻醉及手术操作对患者神经内分泌系统功能的影响,减少了麻醉损伤,且术后恶心呕吐等不良反应发生率较低,值得推广应用。

Application of fast-track anesthesia in the surgery for colorectal cancer in elderly patients

Objective To discuss the clinical effects of fast-track anesthesia in the surgery for colorectal cancer in elderly patients. Methods Ninety-two elderly patients with colorectal cancer undergoing laparoscopic surgery were randomly divided into observation group（n=46） and control group（n=46）. The observation group was given fast-track anesthesia, and the control group was given general inhalation anesthesia. And then the Steward scores and neuroendocrine changes were compared between the two groups. Results There were more patients with Steward≥4 after operation in the observation group than that in the control group（P〈0.01）, and the postoperative extubation time in the observation group was significantly shorter than that in the control group（P〈0.01）. There were no significantly differences in plasma cortisol and glucose concentrations between the two groups before induction of anesthesia（P〉0.05）.However, the plasma cortisol and glucose concentrations after the incision, in the end of surgery, and 1 h postoperative were significantly lower in the observation group than those in the control group（P〈0.05 or P〈0.01）. Meanwhile, the incidence of nausea and vomiting postoperative in the observation group was significantly lower than that in the control group（P〈0.01）. Conclusion Fast-track anesthesia is worthy of promotion because of its faster postoperative recovery, less influence of anesthesia and surgical operations on patients＇ neuroendocrine system function, less damage of anesthesia, and lower incidence of adverse reactions such as postoperative nausea and vomiting.