快速康复食管癌外科的麻醉管理分析

目的：通过比较静脉全麻与静脉全麻加硬膜外阻滞对食管癌患者术后情况的影响,分析快速康复食管癌外科的麻醉管理。方法：选取年龄在70岁以下,ASA分级Ⅰ～Ⅱ级,无特殊并发症的食管癌手术患者80例,随机分成两组,每组40例,分别采用静脉全麻（对照组）和静脉全麻加硬膜外阻滞（研究组）的方法处理,测定两组患者在手术过程中的循环功能和呼吸功能的变化,麻醉用药量以及麻醉恢复时间的差异。结果：研究组在麻醉诱导前、插管后、切皮后和拔管时平均动脉压（13.10±1.67）kPa,（12.89±1.22）kPa,（11.08±1.76）kPa,（12.80±1.45）kPa]和心率（85.82±9.98）次/min,（86.44±9.25）次/min,（72.23±9.78）次/min,（84.19±8.97）次/min]）较对照组的平均动脉压（12.91±1.28）kPa,（14.83±1.39）kPa,（11.79±1.25）kPa,（12.66±1.28）kPa]和心率（85.78±9.22）次/min,（98.08±9.10）次/min,（74.82±7.88）次/min,（88.80±1.45）次/min]显著稳定（P〈0.05）;较麻醉诱导前,对照组RR（18.75±2.44）次/min,MV（7.76±0.78）L,SpO2（97.00±0.74）%）]和研究组RR（18.69±2.57）次/min,MV（7.55±0.82）L,SpO2（97.29±0.88）%]患者拔管后的呼吸功能表现为明显抑制（P〈0.01）;研究组麻醉剂普鲁卡因、潘库溴铵和芬太尼用量（425.21±72.65）mg,（7.68±1.26）mg,（1.01±0.08）mg]明显低于对照组（584.18±66.78）mg,（10.07±1.78）mg,（1.92±0.17）mg]（P〈0.05）;麻醉恢复情况也有显著差异（P〈0.05）。结论：静脉全麻加硬膜外阻滞的方法能够有效降低手术中的应激,减少麻醉剂量,减少恢复时间,在术中血压和心率控制,术后恢复中均优于静脉全麻。

Analysis of the anesthetic management of esophageal cancer's rapid rehabilitation surgery

Objective： To analyze the anesthetic management of esophageal cancer＇s rapid rehabilitation surgery through comparing the situations after operations between intravenous anesthesia and epidural block.Methods： 80 patients with esophageal cancer were randomly divided into two groups,and all of them were younger than 70 years old,ASA level Ⅰ～Ⅱ,without any complications.Each group had 40 patients and the two groups were treated with intravenous anesthesia（control group） and epidural block combined with intravenous anesthesia（experiment group） separately.To assay the function of circulatory system and respiratory system;the amount of anesthetic and the time of recovery after operation were compared.Results： It had been found that MAP （13.10±1.67） kPa,（12.89±1.22） kPa,（11.08±1.76） kPa,（12.80±1.45） kPa] and HR （85.82±9.98） times/min,（86.44±9.25） times/min,（72.23±9.78） times/min,（84.19±8.97） times/min] of experiment group were more stable than MAP （12.91±1.28） kPa,（14.83±1.39） kPa,（11.79±1.25） kPa,（12.66±1.28） kPa] and RR （85.78±9.22） times/min,（98.08±9.10） times/min,（74.82±7.88） times/min,（88.80±1.45） times/min] in control group（P0.05）.After extubation,respiratory function of control group RR（18.75±2.44） times/min,MV（7.76±0.78） L,SpO2（97.00±0.74）%）] and experiment group RR（18.69±2.57） times/min,MV（7.55±0.82） L,SpO2（97.29±0.88）%] showed significant inhibition（P0.01）;the amount of procaine,pancuronium and fentanyl in experimental group （425.21±72.65） mg,（7.68±1.26） mg,（1.01±0.08） mg] was less than control group （584.18±66.78） mg,（10.07±1.78） mg,（1.92±0.17） mg]（P0.05）;and there was significant difference in anesthesia recovery situation（P0.05）.Conclusion： Epidural block can reduce the stress reaction in the operation,reduce the amount of anesthetic and the time of recovery significantly.Epidural block,compared with intravenous anesthesia,is a better method in the control of MAP,HR and postoperative recovery.