瑞芬太尼联合硬膜外麻醉在胃癌根治术中的应用及对血流动力学的影响

目的研究瑞芬太尼联合硬膜外麻醉在胃癌根治术中的应用效果以及对患者血流动力学的影响。方法选取2018年1月至2019年12月海南西部中心医院收治的100例行胃癌D2根治手术的患者作为研究对象。按照麻醉方式不同分为两组,各50例。联合组采用瑞芬太尼联合硬膜外麻醉,对照组仅行全身麻醉。比较两组患者手术相关指标、血流动力学指标、应激反应指标、出室前Steward苏醒评分、术后24 h疼痛评分(VAS)及并发症发生情况。结果联合组丙泊酚、瑞芬太尼用量少于对照组,拔管时间、苏醒时间优于对照组(P<0.05);两组手术时间、术中出血量、术中输液量及各时间点麻醉深度指数(CSI)差异无统计学意义。两组心率(HR)、平均动脉压(MAP)、收缩压(SBP)、舒张压(DBP)麻醉前差异均无统计学意义,但麻醉后60 min、拔管后10 min时联合组明显低于对照组(P<0.05)。术后3、7 d时联合组应激指标皮质醇(Cor)、去甲肾上腺素(Ne)、总抗氧化能力(TAC)水平明显低于对照组(P<0.05)。联合组Steward苏醒评分及术后24 h VAS评分均优于对照组(P<0.05)。结论瑞芬太尼联合硬膜外麻醉应用于胃癌根治术能够促进患者苏醒,维持患者术中血流动力学稳定,降低应激反应,缓解术后疼痛,安全可行,可在临床推广。

Effect of remifentanil combined with epidural anesthesia on hemodynamics in patients with radical gastrectomy

Objective To investigate the effect of remifentanil combined with epidural anesthesia in radical gastrectomy for gastric cancer and its effect on hemodynamics.Methods A total of 100 patients undergoing radical gastrectomy D2 in Hainan Western Central Hospital from January 2018 to December 2019 were selected as study subjects.They were divided into two groups according to different anesthesia methods:the combination group was given remifentanil combined with epidural anesthesia,while the control group was given general anesthesia only.The operative indicators,hemodynamic indicators,stress response indicators,Steward recovery score before ventricle,pain score 24 h after surgery and complications were compared between the two groups.Results The dosage of propofol and remifentanil in the combination group was less than that in the control group,and the extubation time and wake time was better than those in the control group(P<0.05).There were no statistically significant differences in operative time,intraoperative blood loss,intraoperative infusion volume,and cerebral state index(CSI)at each time point between the two groups.There were no statistically significant differences in HR,MAP,SBP and DBP between the two groups before anesthesia.HR,MAP,SBP and DBP in the combination group were significantly lower than those in the control group at 60 min after anesthesia and 10 min after extubation(P<0.05).At 3 d and 7 d postoperatively,the levels of Cor,Ne and TAC in the combination group were significantly lower than those in the control group(P<0.05).Steward recovery score and VAS score 24 h after surgery in the combination group were better than those in the control group(P<0.05).Conclusions The application of remifentanil combined with epidural anesthesia in radical gastrectomy for gastric cancer patients can promote patients’recovery,maintain the intraoperative hemodynamic stability,reduce stress response,and relieve postoperative pain.It is safe and feasible,and can be promoted in clinical practice.