椎旁阻滞联合全麻对结直肠癌切除术患者术后应激反应的影响

目的:探讨椎旁阻滞联合全麻对结直肠癌切除术患者术后应激反应的影响。方法:回顾性分析我院自2015年1月至2017年1月收治的结直肠癌患者104例，根据患者术中采用的麻醉方法，将患者分为观察组(n=58)和对照组(n=46)，观察组术中给予椎旁阻滞联合全麻，对照组仅给予全麻。观察两组患者术后应激反应和术后康复情况。结果:两组患者术前应激激素血管紧张素II(AngII)、C反应蛋白(CRP)、皮质醇、焦虑自我评分(SAS)等比较差异均无统计学意义(P>0.05)；术后24 h时观察组AngII显著低于对照组(P=0.001)，CRP显著低于对照组(P=0.000)，皮质醇显著低于对照组(P=0.009)；与对照组比较，观察组患者术后24 h时SAS评分显著降低(P=0.000)，视觉模拟评分显著降低(P=0.001)；肛门排气时间显著减短(P=0.002)；住院时间显著缩短(P=0.003)，术后引流时间、引流量比较两组间无差异性（P>0.05）。结论:椎旁阻滞联合全麻有助于降低结直肠癌患者术后应激反应，加速患者术后康复。

The effect of paravertebral block combined with general anesthesia on postoperative stress response in patients undergoing resection of colorectal cancer

Objective:To investigate the effect of paravertebral block combined with general anesthesia on postoperative stress response in patients undergoing resection of colorectal cancer.Methods:From January 2015 to January 2017，a retrospective analysis of 104 patients with colorectal cancer in our hospital was held.According to the method of anesthesia the patients received during the operation，all patients were assigned into an observation group (n=58) and a control group (n=46).The patients in the observation group received paravertebral block combined with general anesthesia while patients in the control group received general anesthesia only.The postoperative stress response and recovery of the both groups were studied.Results:There were no significant differences between the two groups in stress hormone angiotensin II (AngII)，C reactive protein (CRP)，self-rating anxiety score (SAS) and cortisol before the operation (P>0.05).At 24 hours after operation，the AngII of the observation group was significantly lower than that of the control group (P=0.001)，and the CRP of the observation group was significantly lower than that of the control group (P=0.000).Cortisol was significantly lower than that in the control group (P=0.009).Compared with the control group in after 24 h，the SAS score of the patients in the observation group was significantly reduced(P=0.000)，Visual analogue scale significantly reduced(P=0.001)，a shortened exhaust time (P=0.002)，and a reduction in hospital duration (P=0.003).There was no difference between the two groups in postoperative drainage time and volume (P>0.05).Conclusion:Paravertebral block combined with general anesthesia can reduce postoperative stress response in patients with colorectal cancer and accelerate postoperative rehabilitation.