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全麻联合硬膜外阻滞在腔镜食管癌根治术中的应用 被引量:24

Application of general anesthesia combined with epidural blockade on patients undergoing thoracoscopic and laparoscopic esophagectomy
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摘要 目的探讨全麻联合硬膜外阻滞对腔镜食管癌根治术患者术后转归的影响。方法选择择期拟行腔镜食管癌根治术患者47例,男29例,女18例,年龄18~65岁,ASAⅠ或Ⅱ级,随机分为全麻联合硬膜外组(E组,n=24)和全麻组(G组,n=23)。E组患者在全麻诱导前行T8~9间隙硬膜外穿刺并置管,给予0.25%罗哌卡因5ml,出现麻醉平面后再行全麻诱导。两组均静注咪达唑仑0.03mg/kg、舒芬太尼1.0μg/kg、TCI丙泊酚以初始血浆药物浓度1.5μg/ml,当达到设定血浆药物浓度后以0.3μg/ml逐级递增,直至BIS稳定于60以下时静注罗库溴铵0.9mg/kg,行双腔气管导管插管。术中使用丙泊酚TCI、七氟醚补充吸入、瑞芬太尼持续输注、间断静脉注射顺式阿曲库铵维持麻醉。术中BIS维持在45~60;BP维持在基础值±20%之间;体温保护;限制性输液;单肺通气期间实施肺保护通气管理;术毕给予镇痛。E组使用硬膜外镇痛泵,G组使用静脉镇痛泵。记录入室时(T0)、插管后5min(T1)、手术开始后10min(T2)、单肺通气开始1h(T3)、单肺通气结束10min(T4)、手术结束即刻(T5)、拔管即刻(T6)、出PACU(T7)时的SBP、DBP、HR、SpO2,记录患者术中用药情况。记录术后第1、3天短期并发症发生情况与静息痛VAS评分;于术前1d和术后第7天对患者认知功能进行评估。结果E组拔管时间、PACU时间、住院时间明显短于G组(P〈0.05);E组T4~T6时的SBP明显低于G组(P〈0.05),T5时的DBP明显低于G组(P〈0.05),T6、T7时的HR明显慢于G组(P〈0.05);E组术中瑞芬太尼用量明显少于G组(P〈0.05),去氧肾上腺素用量明显多于G组(P〈0.05);E组术后躁动发生率明显低于G组(P〈0.05);E组在术后第1、3天的静息痛(VAS)评分明显低于G组(P〈0.05);E组术后第7天认知功能障碍(POCD)发生率明显低于G组(P〈0.05)。结论全麻联合硬膜外阻滞可明显改善食管癌患者� Objective To evaluate effects of general anesthesia combined with epidural blockade under multimodal intraoperative monitoring on postoperation outcomes of patients undergoing thoracoscopic and laparoscopic esophagectomy. Methods Forty-seven patients , male 29 and female t8,ASA I or II, aged 18-65 years accepted thoracoscopic and laparoscopic esophagectomy were recruited and randomly divided into general anesthesia combined with epidural blockade group (group E, n=24) and general anesthesia group (group G, n=23). Patients in group E accepted epidural puncture and catheter before anesthesia induction in the intervertebral space of T8-9, 5ml 0. 25 % ropivacaine infused into the epidural space, proceeding anesthesia induction once the anesthesia level appear. The anesthesia induction of two groups were the same.. 0. 3 mg/kg midazolam iv, sufentanil 1.0μg/kg iv, propofol in initial target plasma concentration of 1.5μg/ml target controlled infusion (TCI) ,when reaching the setting plasma concentration, gradually increase concentration by 0. 3 μg/ ml until the Bispectral index(BIS) less than 60, rocuronium bromide 0. 9 mg/kg iv. All patients were anesthetized with double lumen tube. Intraoperative anesthesia was maintained by propofol TCI, sevoflurane inhalation, remifentanii continuous intravenous infusion, and cis-atracurium intermittent infusion. Multimodal intraoperative monitoring was applied during operation., the BIS maintained between 45-60% hemodynamic maintain at the range of the scope of the basic line+ 20% temperature protection performed; the restrictive transfusion strategy performed; lung protective ventilation strategy during one-lung ventilation performed; At the end of surgery, patients accepted multi-mode postoperative analgesia, and patients in group E had epidural analgesia pumps and patients in group G had vein analgesia pumps. The SBP,DBP, HR, SpO2 were recorded at entering the operating room (T0), 5 min after intubation (T1), 10 min after the start of operation (T
出处 《临床麻醉学杂志》 CAS CSCD 北大核心 2016年第1期53-57,共5页 Journal of Clinical Anesthesiology
关键词 硬膜外阻滞 食管癌根治术 术后转归 术后认知功能障碍 Epidural anesthesia Esophagectomy Postoperation outcome Postoperative cognitive dysfunction
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