硬膜外复合全身麻醉对肝叶切除术围术期血流动力学及苏醒质量的影响
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摘要
目的探究硬膜外麻醉复合全身麻醉应用于肝叶切除术的临床效果。方法选取60例择期行肝叶切除术患者为受试对象,随机数表法分为观察组与对照组各30例。观察组予以硬膜外麻醉复合全身麻醉,对照组则单纯采取全身麻醉。比较麻醉前(T0)、切皮前(T1)、腹腔探查后(T2)、术毕前(T3)、拔管后(T4),两组血流动力学指标[平均动脉压(MAP)、心率(HR)、外周血管阻力(SVR)]、血浆应激状态指标[内皮素(ET)、皮质醇(Cor)、肾上腺素]水平变化,分析两组全麻药物用量、苏醒质量指标差异。结果 T1、T2时,两组MAP、HR、SVR水平均较T0时有显著下降(P <0. 05),但组间同期比较均无统计学意义(P> 0. 05)。T3、T4时,两组MAP、HR、SVR水平均较T0时无明显变化,且组间同期比较均无统计学意义(P>0. 05)。T1时,两组血浆ET、Cor、肾上腺素水平较T0时无明显变化,且组间同期比较均无统计学意义(P> 0. 05)。T2、T3、T4时,两组血浆ET、Cor、肾上腺素水平均较T0时有显著提升,且观察组明显低于同期对照组(P <0. 05)。观察组术中全麻药物用量及术后苏醒质量指标均明显少于对照组(P <0. 05)。结论硬膜外麻醉复合全身麻醉能维持肝叶切除术患者围术期血流动力学处于适宜手术操作的水平,并有效改善术后苏醒质量,对改善其麻醉满意度有利。
Objective To explore the clinical effects of epidural anesthesia combined with general anesthesia for hepatectomy.Methods 60 cases of patients undergoing elective hepalobectomy were selected for the study and were divided into observation group and control group according to the random number table method,with 30 cases in each group. Observation group was given epidural anesthesia combined with general anesthesia,and control group was given simple general anesthesia. The levels of hemodynamic force indexes [mean arterial pressure(MAP),heart rate(HR),peripheral systemic vascular resistance(SVR) ]and plasma stress status indicators [endothelin(ET),cortisol(Cor),adrenaline]were compared between the two groups before anesthesia(T0),before skin incision(T1),after abdominal exploration(T2),before the end of operation(T3) and after extubation(T4). And the dosage of general anesthetic drugs and the recovery quality indicators were analyzed in the two groups. Results At T1 and T2,the levels of MAP,HR and SVR in the two groups were significantly lower than those at T0(P < 0. 05),but there were no significant differences between the two groups at the same time period(P > 0. 05). At T3 and T4,there were no significant changes in levels of MAP,HR and SVR in the two groups compared with those at T0,and there were no significant differences between the two groups at the same time period(P > 0. 05). At T1,there were no significant changes in the levels of plasma ET,Cor and adrenaline between the two groups compared with those at T0,and there were no significant differences between the two groups at the same time period(P > 0. 05). At T2,T3 and T4,the levels of plasma ET,Cor and adrenaline were significantly higher than those at T0,and the levels in observation group were significantly lower than those in control group(P < 0. 05). The dosage of general anesthetic drugs and the postoperative recovery quality indicators in observation group were significantly lower than those in control group(P < 0. 05). Conclusion s Epidural anesthesia combined with general anesthesia for patients with hepalobectomy can maintain the perioperative hemodynamic force in an ideal state,and effectively improve the postoperative recovery quality,and it is beneficial to optimize the satisfaction of anesthesia.
Objective To explore the clinical effects of epidural anesthesia combined with general anesthesia for hepatectomy.Methods 60 cases of patients undergoing elective hepalobectomy were selected for the study and were divided into observation group and control group according to the random number table method,with 30 cases in each group. Observation group was given epidural anesthesia combined with general anesthesia,and control group was given simple general anesthesia. The levels of hemodynamic force indexes [mean arterial pressure(MAP),heart rate(HR),peripheral systemic vascular resistance(SVR) ]and plasma stress status indicators [endothelin(ET),cortisol(Cor),adrenaline]were compared between the two groups before anesthesia(T0),before skin incision(T1),after abdominal exploration(T2),before the end of operation(T3) and after extubation(T4). And the dosage of general anesthetic drugs and the recovery quality indicators were analyzed in the two groups. Results At T1 and T2,the levels of MAP,HR and SVR in the two groups were significantly lower than those at T0(P < 0. 05),but there were no significant differences between the two groups at the same time period(P > 0. 05). At T3 and T4,there were no significant changes in levels of MAP,HR and SVR in the two groups compared with those at T0,and there were no significant differences between the two groups at the same time period(P > 0. 05). At T1,there were no significant changes in the levels of plasma ET,Cor and adrenaline between the two groups compared with those at T0,and there were no significant differences between the two groups at the same time period(P > 0. 05). At T2,T3 and T4,the levels of plasma ET,Cor and adrenaline were significantly higher than those at T0,and the levels in observation group were significantly lower than those in control group(P < 0. 05). The dosage of general anesthetic drugs and the postoperative recovery quality indicators in observation group were significantly lower than those in control group(P < 0. 05). Conclusion s Epidural anesthesia combined with general anesthesia for patients with hepalobectomy can maintain the perioperative hemodynamic force in an ideal state,and effectively improve the postoperative recovery quality,and it is beneficial to optimize the satisfaction of anesthesia.
引文
1祁夫魁,陈平,马宽生,等.解剖性肝叶切除术在肝胆外科中的临床研究.肝胆外科杂志,2013,21(6):435-438.
2蔡晓飞,牛少宁,丁乔,等.不同麻醉药物行全身麻醉复合硬膜外阻滞对肝脏切除术后肝肾功能的影响.首都医科大学学报,2017,38(3):352-356.
3姜龙,梁小东,姜平.全身麻醉分子机制研究进展.临床军医杂志,2016,44(02):209-212.
4阮绪广,江伟航,程平瑞,等.全身麻醉复合硬膜外麻醉对老年胆囊切除术患者术后认知功能的影响.山东医药,2015,55(28):69-70.
5王泽华,胡文庆,郭焱,等.全身麻醉复合硬膜外麻醉对胃癌根治术患者肺功能及术后肺部感染的影响.中华医院感染学杂志,2017,27(6):1301-1304.
6蔡强.全身麻醉复合硬膜外麻醉对老年腹部手术患者术后肺部感染及肺功能的影响.中国老年学杂志,2017,37(09):2241-2243.
7中华医学会外科学分会肝脏外科学组.腹腔镜肝切除术专家共识和手术操作指南(2013版).中华外科杂志,2013,51(4):289-292.
8 Apfelbaum J L,Connis R T,Nickinovich D G,et al.Practice advisory for preanesthesia evaluation:an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation.Anesthesiology,2012,116(3):522-538.
9姚汝铖.肝切除安全性评估方法及临床应用的研究进展.医学研究生学报,2013,26(6):662-665.
10赵延涛,冯仙菊,王静,等.不同麻醉方式对肝癌切除患者术后感染影响的研究.中华医院感染学杂志,2014,24(18):4566-4568.
11李敏,王浩,缪长虹,等.舒芬太尼靶控输注用于肝脏部分切除术的准确性评价.上海医学,2013,36(2):109-113.
12袁颖平,张汉湘.胸部硬膜外麻醉联合静脉复合麻醉对肝癌切除术患者免疫功能和机体应激的影响.肝脏,2018,23(06):514-517.
13肖锋,江兴华,李晋,等.超声引导腹横肌平面阻滞在机器人辅助肝叶切除术中的应用.中国医师杂志,2017,19(7):1065-1067.
14李懔,魏萌,张敏,等.不同麻醉方式对老年骨科手术患者术中应激反应及血流动力学学的影响.海南医学院学报,2017,23(14):1922-1925.
2蔡晓飞,牛少宁,丁乔,等.不同麻醉药物行全身麻醉复合硬膜外阻滞对肝脏切除术后肝肾功能的影响.首都医科大学学报,2017,38(3):352-356.
3姜龙,梁小东,姜平.全身麻醉分子机制研究进展.临床军医杂志,2016,44(02):209-212.
4阮绪广,江伟航,程平瑞,等.全身麻醉复合硬膜外麻醉对老年胆囊切除术患者术后认知功能的影响.山东医药,2015,55(28):69-70.
5王泽华,胡文庆,郭焱,等.全身麻醉复合硬膜外麻醉对胃癌根治术患者肺功能及术后肺部感染的影响.中华医院感染学杂志,2017,27(6):1301-1304.
6蔡强.全身麻醉复合硬膜外麻醉对老年腹部手术患者术后肺部感染及肺功能的影响.中国老年学杂志,2017,37(09):2241-2243.
7中华医学会外科学分会肝脏外科学组.腹腔镜肝切除术专家共识和手术操作指南(2013版).中华外科杂志,2013,51(4):289-292.
8 Apfelbaum J L,Connis R T,Nickinovich D G,et al.Practice advisory for preanesthesia evaluation:an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation.Anesthesiology,2012,116(3):522-538.
9姚汝铖.肝切除安全性评估方法及临床应用的研究进展.医学研究生学报,2013,26(6):662-665.
10赵延涛,冯仙菊,王静,等.不同麻醉方式对肝癌切除患者术后感染影响的研究.中华医院感染学杂志,2014,24(18):4566-4568.
11李敏,王浩,缪长虹,等.舒芬太尼靶控输注用于肝脏部分切除术的准确性评价.上海医学,2013,36(2):109-113.
12袁颖平,张汉湘.胸部硬膜外麻醉联合静脉复合麻醉对肝癌切除术患者免疫功能和机体应激的影响.肝脏,2018,23(06):514-517.
13肖锋,江兴华,李晋,等.超声引导腹横肌平面阻滞在机器人辅助肝叶切除术中的应用.中国医师杂志,2017,19(7):1065-1067.
14李懔,魏萌,张敏,等.不同麻醉方式对老年骨科手术患者术中应激反应及血流动力学学的影响.海南医学院学报,2017,23(14):1922-1925.