全凭静脉麻醉与全麻复合硬膜外阻滞对肺癌术后疼痛状态的差异性研究
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摘要
目的探讨全凭静脉麻醉(TIVA)与全麻复合硬膜外阻滞(CGEA)对肺癌术后疼痛状态的差异性。方法选取行手术治疗的肺癌患者91例,采用随机数字表法分为TIVA组45例,CGEA组46例。TIVA组:缓慢静脉注射咪达唑仑0. 04～0. 06 mg/Kg;舒芬太尼0. 4～0. 6μg/Kg,顺苯磺酸阿曲库铵0. 15 mg/Kg,丙泊酚1. 0 mg/Kg。完成诱导麻醉后进行喉镜下气管插管,实施机械通气。维持麻醉方法:微量泵泵入顺苯磺酸阿曲库铵2 ug/(Kg·min)、丙泊酚5 mg/(Kg·h)、瑞芬太尼0. 15μg/(Kg·min); CGEA组:诱导麻醉方法同上,选取T7～T8椎间隙为穿刺点,进行硬膜外穿刺并放置硬膜外导管,维持麻醉方法:0. 5%盐酸利多卡因术中通过导管给药,每30 min给药一次,每次5 m L。结果 CGEA组患者在拔管时间、苏醒时间方面均优于TIVA组,CGEA组感染发生率低于TIVA组,术后5、10 h两个时间点评分CGEA组优于TIVA组。结论肺癌手术患者选择CGEA麻醉方式,可有效改善术后疼痛状态,减少并发症。
Objective To investigate the difference of postoperative pain status of lung cancer with total intravenous anesthesia( TIVA) combined with general anesthesia combined with epidural analgesia( CGEA). Methods A total of 91 patients with lung cancer who underwent surgical treatment were randomly divided into the TIVA group( 45 cases) and the CGEA group( 46 cases). In the TIVA group,midazolam 0. 04 to 0. 06 mg/Kg was intravenously administered intravenously; 0. 4 to 0. 6 μg/Kg of sufentanil,0. 15 mg/Kg of atracurium cis-benzensulfonate,and 1. 0 mg/Kg of propofol. After induction of anesthesia was completed,laryngoscope tracheal intubation was performed and mechanical ventilation was performed. Maintenance of anesthetic method: A micropump was pumped with atracurium sulfoxamate 2 ug/( Kg·min),propofol 5 mg/( Kg·h),and remifentanil 0. 15 μg/( Kg·min). CGEA group: Induction of anesthesia was the same as above. T7-T8 disc space was selected as the puncture site. Epidural puncture was performed and an epidural catheter was placed. Anesthesia was maintained. 0. 5% lidocaine hydrochloride was administered through the catheter every 30 minutes. Dosing once,5 m L each time. Results The patients in the CGEA group were superior to the TIVA group in terms of extubation time and recovery time. The incidence of infection was lower in the CGEA group than in the TIVA group. The scores in the CGAA group were better than those in the TIVA group at 5 hours and 10 hours after the operation. Conclusion The choice of CGEA anesthesia for lung cancer patients can effectively improve postoperative pain and reduce complications.
Objective To investigate the difference of postoperative pain status of lung cancer with total intravenous anesthesia( TIVA) combined with general anesthesia combined with epidural analgesia( CGEA). Methods A total of 91 patients with lung cancer who underwent surgical treatment were randomly divided into the TIVA group( 45 cases) and the CGEA group( 46 cases). In the TIVA group,midazolam 0. 04 to 0. 06 mg/Kg was intravenously administered intravenously; 0. 4 to 0. 6 μg/Kg of sufentanil,0. 15 mg/Kg of atracurium cis-benzensulfonate,and 1. 0 mg/Kg of propofol. After induction of anesthesia was completed,laryngoscope tracheal intubation was performed and mechanical ventilation was performed. Maintenance of anesthetic method: A micropump was pumped with atracurium sulfoxamate 2 ug/( Kg·min),propofol 5 mg/( Kg·h),and remifentanil 0. 15 μg/( Kg·min). CGEA group: Induction of anesthesia was the same as above. T7-T8 disc space was selected as the puncture site. Epidural puncture was performed and an epidural catheter was placed. Anesthesia was maintained. 0. 5% lidocaine hydrochloride was administered through the catheter every 30 minutes. Dosing once,5 m L each time. Results The patients in the CGEA group were superior to the TIVA group in terms of extubation time and recovery time. The incidence of infection was lower in the CGEA group than in the TIVA group. The scores in the CGAA group were better than those in the TIVA group at 5 hours and 10 hours after the operation. Conclusion The choice of CGEA anesthesia for lung cancer patients can effectively improve postoperative pain and reduce complications.
引文
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[10]Yeung J,Melody T,Kerr A,et al. Randomised controlled pilot study to investigate the effectiveness of thoracic epidural and paravertebral blockade in reducing chronic post-thoracotomy pain:TOPIC feasibility study protocol[J]. BMJ Open,2016,6(12):e012735.
[11]张倩,尤浩军.超前镇痛研究进展及麻醉中应用[J].中国疼痛医学杂志,2016,22(4):241-244.
[12]赵而飞,武咏,张学林.老年患者不同麻醉方式下腹部良性肿瘤切除术后肺部感染情况分析[J].中华实用诊断与治疗杂志,2016,30(8):826-828.
[2]毕翻利,高洁,党璐.不同麻醉方式对早期肺癌术后感染率及疼痛状态的影响[J].湖南师范大学学报,2018,15(2):67-69.
[3]张晓敏.全麻复合硬膜外阻滞麻醉的术中观察与护理[J].当代临床医刊,2017,30(5):3374,3360.
[4]王成连,雷恩骏.芬太尼透皮贴剂复合硬膜外超前镇痛对肺癌患者术后疼痛影响的临床研究[J].中国医学创新,2018,15(13):17-22.
[5]王薇,刘素兰.芬太尼透皮贴剂联合自控静脉镇痛对腹部手术后疼痛程度应激程度的影响[J].安徽医学,2017,38(8):1055-1058.
[6]杨静,夏氢,何伟.胸椎旁神经阻滞对胸腔镜肺癌根治术后疼痛程度、应激反应、免疫应答的影响[J].海南医学院学报,2018,24(3):357-360.
[7]胡祚铭.椎管内麻醉方法及并发症研究新进展[J].世界最新医学信息文摘,2016,16(67):48-49.
[8]林毅.全麻与全麻复合硬膜外阻滞用于开胸手术的对比研究[J].重庆医学,2015,34(4):538-539.
[9]王丽珺,仓静,薛张纲.不同麻醉方式对开胸患者术后并发症的影响[J].中国临床医学,2011,18(2):230-233.
[10]Yeung J,Melody T,Kerr A,et al. Randomised controlled pilot study to investigate the effectiveness of thoracic epidural and paravertebral blockade in reducing chronic post-thoracotomy pain:TOPIC feasibility study protocol[J]. BMJ Open,2016,6(12):e012735.
[11]张倩,尤浩军.超前镇痛研究进展及麻醉中应用[J].中国疼痛医学杂志,2016,22(4):241-244.
[12]赵而飞,武咏,张学林.老年患者不同麻醉方式下腹部良性肿瘤切除术后肺部感染情况分析[J].中华实用诊断与治疗杂志,2016,30(8):826-828.