全身麻醉联合硬膜外麻醉在直肠癌根治术中的麻醉疗效观察

张媛

【摘要】 目的 探究全身麻醉聯合硬膜外麻醉在直肠癌根治术中的麻醉疗效。方法 80例拟行直肠癌根治术患者， 按随机数字表法分为联合组与全麻组， 各40例。全麻组实施全身麻醉， 联合组实施全身麻醉联合硬膜外麻醉。比较两组喉罩拔出前及喉罩拔出1、5 min Richmond躁动-镇静评分， 苏醒时间， 麻醉前及麻醉后5 min 动脉血二氧化碳分压（PaCO2）、氧合指数（PaO2/FiO2）， 并发症发生情况。结果 喉罩拔出前， 两组Richmond躁动-镇静评分比较， 差异无统计学意义（P>0.05）;喉罩拔出1、5 min， 联合组Richmond躁动-镇静评分显著低于全麻组， 差异有统计学意义（P<0.05）;联合组苏醒时间（8.43±0.86）min显著短于全麻组的（16.49±1.27）min， 差异有统计学意义（P<0.05）。麻醉前， 两组PaCO2、PaO2/FiO2比较差异无统计学意义（P>0.05）;麻醉后5 min， 联合组PaCO2显著低于全麻组， PaO2/FiO2显著高于全麻组， 差异有统计学意义（P<0.05）。联合组并发症发生率10.00%显著低于全麻组的35.00%， 差异有统计学意义（P<0.05）。结论 将全身麻醉联合硬膜外麻醉应用于直肠癌根治术中， 患者应激反应小， 苏醒时间短， 并发症少， 此方法值得应用与推广。

【关键词】 直肠癌根治术;硬膜外麻醉;全身麻醉

【Abstract】 Objective   To investigate the efficacy of general anesthesia combined with epidural anesthesia in radical resection of rectal cancer. Methods   A total of 80 rectal cancer patients undergoing radical resection were divided into combination group and general anesthesia group， with 40 cases in each group. General anesthesia group received general anesthesia， and combination group received general anesthesia combined with epidural anesthesia. Comparison was made on Richmond agitation sedation score before and 1， 5 min after laryngeal mask extraction， wake-up time， arterial partial pressure of carbon dioxide （PaCO2） and oxygenation index （PaO2/FiO2） before and 5 min after anesthesia and occurrence of complications between the two groups. Results   Before laryngeal mask extraction， there was no statistically significant difference in Richmond agitation sedation score between the two groups （P>0.05）. At 1， 5 min after laryngeal mask extraction， the Richmond agitation sedation score in combination group was significantly lower than those in general anesthesia group， and the difference was statistically significant （P<0.05）. The wake-up time （8.43±0.86） min in combination group was significantly shorter than （16.49±1.27） min in general anesthesia group， and the difference was statistically significant （P<0.05）. Before anesthesia， there was no statistically significant difference in PaCO2 and PaO2/FiO2 between the two groups （P>0.05）. At 5 min after anesthesia， the PaCO2 in combination group was significantly lower than that in general anesthesia group， and PaO2/FiO2 was significantly higher than that in general anesthesia group. Their difference was statistically significant （P<0.05）. The incidence of complications 10.00% in combination group was significantly lower than 35.00% in general anesthesia group， and the difference was statistically significant （P<0.05）. Conclusion   The application of general anesthesia combined with epidural anesthesia in radical resection of rectal cancer has the advantages of small stress response， short wake-up time and less complications. It is worthy of application and promotion.