直肠癌手术病人不同麻醉方法的效果比较

目的比较直肠癌手术病人单纯全麻和硬膜外复合全麻的效果。方法择期行直肠癌手术病人40例，年龄18～78岁，性别不限，ASAⅠ或Ⅱ级，随机分为2组（n=20）：单纯全麻组（Q组）和硬膜外复合全麻组（EQ组）。两组静脉注射咪达唑仑、芬太尼、丙泊酚、维库溴铵麻醉诱导，气管插管后机械通气。Q组静脉泵入瑞芬太尼和丙泊酚维持麻醉；EQ组静脉泵入瑞芬太尼和丙泊酚的同时，间断硬膜外注射利多卡因和布比卡因维持麻醉；两组间断静脉注射维库溴铵维持肌松。术毕入PACU，Q组采用病人自控静脉镇痛；EQ组采用病人自控硬膜外镇痛。记录苏醒时间、拔管时间、PACU停留时间；记录瑞芬太尼、丙泊酚、肌松药和血管活性药物的用量；记录VAS评分情况；记录术后不良反应的发生情况；计算麻醉有关费用。结果与Q组比较，EQ组苏醒时间、拔管时间和PACU停留时间缩短，瑞芬太尼、丙泊酚、肌松药用量减少，麻醉总费用减少（P〈0．05）。血管活性药物的用量、各时点镇痛效果和不良反应发生率差异无统计学意义（P〉0．05）。结论与单纯全麻相比，直肠癌手术病人硬膜外复合全麻药物用量少，术后苏醒快，术后早期镇痛效果好，且麻醉费用亦减少。

Cost-effectiveness of different methods of anesthesia for colorectal surgical procedures

Objective To compare the cost-effectiveness of simple general anesthesia and general anesthesia com- bined with epidural book in patients undergoing colorectal surgical procedures. Methods 40 ASA physical status Ⅰ-Ⅱ , aged 18--78 years old, undergoing colorectal surgery were randomly assigned two groups （n=20）. Q group was anesthetized with GA. EQ group with GA＆CEA. Propofol, fentanyl, midazolam and vecuronium were administered for induction of anesthesia in the two groups, followed by propofol and remifentanil by continuous infusion via a tail vein catheter. Muscle relaxation was achieved with vecuronium. Meanwhile, lidocaine and bupivacaine were used for epidural injection in EQ group. All the patients were sent into PACU after operation. PCIA was used in the Q group, and PCEA in the EQ group. All the data were recorded, including awakening time, time of extubation and staying in PACU, drug dosage, scores of VAS, postoperative adverse reaetions and costs of anesthesia. Results Comparing Q group, the patients in EQ group spent shorter time of awakening, extubation and staying in PACU, less dosage of remifentanil, propofol and vecuronium, less costs of anesthesia （P〈0.05）. There were no significant differences in dosage of vascular active drug, analgesic effect and incidence of postoperative adverse reactions （P〉0. 05）. Conclusion There are lots of advantages in the colorectal surgeries with general anesthesia combined continuous epidural anesthesia,