摘要
目的探讨优化麻醉管理在肺部小结节手术患者加速康复外科的应用效果。方法胸腔镜下肺部小结节切除术患者60例随机均分为两组,分别采用优化麻醉管理(A组)和传统麻醉处理(B组)。优化麻醉管理内容包括术前宣教和麻醉评估、无气管插管、胸段硬膜外麻醉、术中限制性补液、术后多模式镇痛和早期肺功能锻炼。传统麻醉处理包括超前镇痛、全身麻醉、双腔支气管插管、术中采用单肺通气和小潮气量肺保护策略。比较两组麻醉前(T1)、手术开始0.5h(T2)、术毕即刻(T3)、术后24h(T4)和72h(T5)HR和MAP以及CRP、TNF-α、心肌损伤指标、IL-6和IL-1水平。结果与B组比较,A组患者T2~T5的HR和MAP波动较少,心肌损伤指标和炎症反应指标较低(P<0.05或P<0.01),麻醉恢复时间、住院时间和术后并发症发生率也均低于B组(P<0.05)。结论依据加速康复外科理念,在胸腔镜肺部小结节手术采用优化麻醉管理有利于维持患者循环稳定,减轻应激性炎症反应,促进术后康复。
Objective To investigate the outcomes of optimized anesthetic management in perioperative accelerated rehabilitation surgery of the patients undergoing thoracoscopic resection of pulmonary nodules. Methods Sixty patients undergoing thoracoscopic resection of pulmonary nodules were equally assigned into two groups and treated with optimized anesthetic management（group A） and conventional anesthetic management（group B）, respectively. The measures of optimized anesthetic management included preoperative education and anesthesia evaluation, without endotracheal intubation, high epidural anesthesia, intraoperative restrictive liquid treatment, multiple mode analgesia, early postoperative pulmonary function exercise, which of conventional anesthetic management included preemptive analgesia, general anesthesia, double lumen bronchial intubation, intraoperative one-lung ventilation with lung protection strategy of small tidal volume. The indicators of HR and MAP, serum C-reactive protein （CRP）, tumor necrosis factor alpha （TNF-α）, indicators reflecting myocardial damage, IL-6 and IL-1 were detected before anesthesia（T1）, at 30 min（T2）, at the end of surgery（T3） ,in the 24＇h hour（T4） and 48th hour after operation（T5）. Results Compared with group B at T2-T5 ,group A had less fluctuations in HR and MAP, lower levels of the indicators reflecting myocardial damage and stress inflammatory responses （P〈0. 05 or P〈0. 01）, earlier recovery from anesthesia, shorter hospital stay and lower incidence of complications （P〈0. 05）. Conclusion According to the concept of accelerated rehabilitation surgery, taking optimized anesthetic management may effectively maintain stable circulation, attenuate the stress inflammatory responses, and promote the rehabilitation after surgery in the patients undergoing thoracoscopic resection of pulmonary nodules.
作者
陈佩军
何海平
陈燕
程红春
CHEN Peijun;HE Haiping;CHEN Yan;et al(Department of Anesthesiology, Sixth People＇s Hospital of Yancheng , Yancheng 224001, CHINA)
出处
《江苏医药》
CAS
2018年第4期422-425,共4页
Jiangsu Medical Journal
基金
盐城市医学科技发展项目(YK2017122)
关键词
优化麻醉管理
应激性炎症反应
胸腔镜肺部手术
加速康复外科
Optimized anesthetic management
Stress inflammatory responses
Thoracoscopic resection of pulmonary nodules
Accelerated rehabilitation surgery
