胸段硬膜外阻滞联合全麻在快速康复外科中的应用性研究

目的探讨在快速康复外科理念指导下的胸段硬膜外联合全麻对术中应激反应、循环状态以及术后肠功能恢复的影响。方法 44例结直肠癌择期手术的患者随机分为两组:单纯全麻组(Ⅰ组,n=22)、胸段硬膜外阻滞加全麻组(Ⅱ组,n=22)。测定麻醉前、插管后1 min、手术切皮时、切皮后1 h、拔管后1 min血清皮质醇(Cor)、肾上腺素(E)和血糖(Glu)水平,记录循环指标、全麻用药量、术后苏醒时间与拔管时间及术后肠功能恢复时间。结果Ⅰ组Glu于切皮前高于Ⅱ组(P0.05),手术1 h显著高于Ⅱ组(P0.01),Cor与Glu变化一致,Ⅰ组E在气管插管后和拔管后明显升高,Ⅱ组术中较平稳;Ⅰ组平均动脉压(MAP)、心率(HR)手术切皮前及术中1 h波动较大,Ⅱ组术中较平稳,两组差异有统计学意义(P0.05),Ⅱ组的全麻用药明显少于Ⅰ组(P0.01),Ⅱ组术毕拔管时间、清醒时间及通气时间明显短于Ⅰ组(P0.05)。结论在快速康复外科理念指导下的胸段硬膜外联合全麻可明显减轻结直肠手术患者的应激反应,并能有效地促进术后肠功能恢复。

Clinical use of thoracic epidural block combined with generalanesthesia in fast-track colorectal resection

Objective To compare the clinical effect of single general anesthesia with combined general-epidural anesthesia in fast-track colorectal resection.Methods Forty-four patients scheduled for select colorectal resection who were randomly divided into general anesthesia group(GroupⅠ,n=22) and general anesthesia combined with epidural block group(GroupⅡ,n=22).The concentration of serum cortisol,Epinephrine and blood glucose were determined at the following five time points: before anesthesia,at 1 min after tracheal intubation,at incision,at 1 h after incision and at 1 min after tracheal extubation.HR and BP were continuously monitored.Postoperative awakening time,tracheal extubation time and time for passage of flatus were observed and recorded.Results Compared with Group Ⅱ,Glu and Cor were increased during incision(P<0.05) and increased significantly(P<0.01) at 1 h after incision in Group I;MAP and HR were increased significantly(P<0.05),during incision and at 1 h after incision in Group I.Postoperative tracheal extubation time,awakening time and time for passage of flatus were shorter in Group Ⅱ(P<0.05).Conclusions General anesthesia combined with thoracic epidural block may alleviate stress response and shorten intestinal function recovery time in fast-track colorectal resection.