Influence of intravenous general anesthesia combined with epidural anesthesia and with ultrasound-guided bilateral transversus abdominis plane on laparoscopic colorectal cancer patients
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摘要:目的 探讨静脉全身麻醉分别联合硬膜外麻醉与超声引导双侧腹横肌平面(TAP)阻滞对腹腔镜结直肠癌手术患者血流动力学、应激水平及苏醒期躁动的影响。方法 选取102例腹腔镜结直肠癌手术患者为研究对象，按照随机数字表法进行1∶1配对分组，分为联合麻醉组、全麻组、全麻联合TAP组, 每组34例。比较麻醉诱导前10 min(T0)、麻醉诱导后30 min(T1)、停止麻醉时(T2)、拔出气管导管后10 min(T3)时点的收缩压(SBP)、舒张压(DBP)、心率(HR); 评估麻醉前、切皮后、术毕等时点血管紧张素Ⅱ(AngⅡ)、血糖以及麻醉前、气腹建立后、术后24 h的血清免疫球蛋白(Ig)M、IgG变化; 观察术后睁眼时间和躁动评分。结果 T0时点, 3组SBP、DBP、HR比较，差异无统计学意义(P>0.05); T1、T2时点，联合麻醉组SBP、DBP低于全麻组和全麻联合TAP组，差异有统计学意义(P < 0.05); 3组HR比较，差异无统计学意义(P>0.05); T3时点，联合麻醉组SBP、DBP、HR与全麻组和全麻联合TAP组比较，差异无统计学意义(P>0.05)。切皮后、术毕时点，联合麻醉组AngⅡ、血糖低于全麻组和全麻联合TAP组，差异有统计学意义(P < 0.05); 气腹建立后及术后24 h等时点，联合麻醉组IgM、IgG高于全麻组和全麻联合TAP组，差异有统计学意义(P < 0.05)。联合麻醉组睁眼时间、躁动评分均低于全麻组与全麻联合TAP组，差异有统计学意义(P < 0.05)。结论 腹腔镜结直肠癌手术中采用静脉全身麻醉复合硬膜外麻醉，有利于稳定血流动力学和降低应激水平，避免术后躁动事件的发生。Abstract:Objective To investigate the effects of intravenous general anesthesia combined with epidural anesthesia and with ultrasound-guided bilateral transversus abdominis plane (TAP) block on hemodynamics, stress level and agitation during recovery in patients with laparoscopic colorectal cancer surgery.Methods A total of 102 patients undergoing laparoscopic colorectal cancer surgery were selected as research subjects, and were divided into combined anesthesia group (intravenous general anesthesia combined with epidural anesthesia), general anesthesia group (intravenous general anesthesia), and general anesthesia combined with TAP group(intravenous general anesthesia combined with TAP) by 1∶1 pairing according to the random number table method, with 34 cases in each group. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) at 10 min before induction of anesthesia (T0), 30 min after induction of anesthesia (T1), cessation of anesthesia (T2) and 10 min after tracheal tube removal (T3) were compared. The changes of angiotensin Ⅱ(AngⅡ), blood glucose, serum immunoglobulin (Ig) M and IgG before anesthesia, after the establishment of pneumoperitoneum and 24 h after surgery were evaluated. Eye opening time and agitation score were observed.Results There were no significant differences in SBP, DBP and HR among the three groups at time point of T0 (P>0.05); at T1 and T2, the SBP and DBP of the combined anesthesia group showed no statistically significant differences when compared with the general anesthesia group and the general anesthesia combined with TAP group (P < 0.05); there was no significant difference in HR among the three groups (P>0.05); at T3, there were no significant differences in SBP, DBP and HR in the combined anesthesia group compared with the general anesthesia combined with TAP group and general anesthesia group (P>0.05). After skin incision and at the end of the operation, AngII and blood glucose in the combined anesthesia group were lower than those in the general anesthesia combined with TAP group and the general anesthesia group (P < 0.05); after the establishment of pneumoperitoneum and 24 hours after the operation, the IgM and IgG in the combined anesthesia group were higher than those in the general anesthesia group and the general anesthesia combined with TAP group (P < 0.05). The eye opening time was shorter, and agitation score was lower in the combined anesthesia group than those in the general anesthesia group and the general anesthesia combined with TAP group (P < 0.05).Conclusion Intravenous general anesthesia combined with epidural anesthesia in laparoscopic colorectal cancer surgery is beneficial to stabilize hemodynamics, reduce stress levels, and avoid occurrence of postoperative agitation events.
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表 1 3组一般资料比较[n(%)]
组别 性别 年龄/岁 BMI/(kg/m2) ASA 男 女 Ⅰ级 Ⅱ级 联合麻醉组(n=34) 17(50.00) 17(50.00) 57.92±3.38 22.98±2.30 18(52.94) 16(47.06) 全麻组(n=34) 18(52.94) 16(47.06) 58.11±2.96 23.09±2.21 20(58.82) 14(41.18) 全麻联合TAP组(n=34) 15(44.12) 19(55.88) 58.36±2.88 23.15±2.19 19(55.88) 15(44.12) BMI: 体质量指数; ASA: 美国麻醉师协会。 
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表 2 3组血流动力学指标比较(x±s)
指标 组别 n T0 T1 T2 T3 SBP/mmHg 联合麻醉组 34 114.52±12.02 117.25±13.12 116.01±12.68 114.25±11.85 全麻组 34 114.56±11.92 124.92±15.85*# 125.01±15.71*# 115.02±12.05 全麻联合TAP组 34 114.49±12.05 124.65±15.23*# 129.95±15.52*# 115.07±11.95 DBP/mmHg 联合麻醉组 34 76.25±8.52 79.30±10.32 69.78±7.25 77.05±8.45 全麻组 34 76.30±8.48 85.46±12.52*# 82.65±11.52*# 77.11±8.32 全麻联合TAP组 34 76.28±8.55 84.96±12.62*# 81.97±11.56*# 77.09±8.36 HR/(次/min) 联合麻醉组 34 68.52±7.32 70.05±8.12 68.36±6.52 68.82±7.25 全麻组 34 68.47±7.30 70.12±8.05 69.05±6.41 68.52±7.15 全麻联合TAP组 34 68.55±7.29 70.18±8.08 69.11±6.44 68.63±7.19 T0: 麻醉诱导前10 min; T1: 麻醉诱导后30 min; T2: 停止麻醉时; T3: 拔出气管导管后10 min; SBP: 收缩压;
DBP: 舒张压; HR: 心率。与T0时点比较, *P < 0.05; 与联合麻醉组比较, #P < 0.05。
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表 3 3组应激指标比较(x±s)
指标 组别 n 麻醉前 切皮后 术毕 血管紧张素Ⅱ/(ng/L) 联合麻醉组 34 26.32±6.02 27.02±6.25 32.52±7.02* 全麻组 34 26.36±5.95 33.45±8.12*△ 39.85±9.12*#△ 全麻联合TAP组 34 26.30±12.05 34.05±8.25*△ 40.05±9.18*#△ 血糖/(mmol/L) 联合麻醉组 34 5.21±1.25 5.32±1.74 5.48±1.80 全麻组 34 5.18±1.28 6.25±2.05*△ 7.69±2.52*#△ 全麻联合TAP组 34 5.24±1.22 6.30±2.14*△ 7.72±2.58*#△ 与麻醉前比较, *P < 0.05; 与切皮后比较, #P < 0.05; 与联合麻醉组比较, △P < 0.05。
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表 4 3组血清IgM、IgG比较(x±s)
g/L 指标 组别 n 麻醉前 气腹建立后 术后24 h 免疫球蛋白M 联合麻醉组 34 1.19±0.25 1.15±0.17 1.10±0.15 全麻组 34 1.22±0.18 1.02±0.11*△ 0.94±0.10*#△ 全麻联合TAP组 34 1.17±0.26 1.04±0.13*△ 0.90±0.08*#△ 免疫球蛋白G 联合麻醉组 34 7.42±1.62 7.20±1.32 7.08±1.18 全麻组 34 7.40±1.65 6.25±1.11*△ 5.92±1.03*△ 全麻联合TAP组 34 7.45±1.68 6.17±1.05*△ 5.85±0.95*△ 与麻醉前比较, *P < 0.05; 与气腹建立后比较, #P < 0.05; 与联合麻醉组比较, △P < 0.05。
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表 5 3组术后苏醒时间和躁动评分比较(x±s)
组别 n 睁眼时间/min 躁动评分/分 联合麻醉组 34 4.52±1.07 0.51±0.12 全麻组 34 8.79±1.25* 1.89±0.36* 全麻联合TAP组 34 9.02±1.32* 1.92±0.42* 与联合麻醉组比较, *P < 0.05。
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[1] 郑紫恒, 周英发, 任景丽, 等. hMLH1、hMSH2、hMSH6在中青年散发性结直肠癌中的表达及对预后的影响[J]. 郑州大学学报: 医学版, 2018, 53(2): 165-170. [2] 李亦凡, 刘智慧, 童贻捷. 靶控输注舒芬太尼和瑞芬太尼复合麻醉在腹腔镜结直肠癌根治术中的应用效果[J]. 实用临床医药杂志, 2020, 24(19): 114-117. doi: 10.7619/jcmp.202019033 [3] 中华医学会外科学分会腹腔镜与内镜外科学组, 中华医学会外科学分会结直肠外科学组, 中国医师协会外科医师分会结直肠外科医师委员会, 等. 腹腔镜结直肠癌根治术操作指南(2018版)[J]. 中华消化外科杂志, 2018, 17(9): 877-885. doi: 10.3760/cma.j.issn.1673-9752.2018.09.001 [4] 白如, 张经, 王超. 腹腔镜手术与开腹手术在结直肠癌根治术中临床疗效及远期疗效的对比研究[J]. 中国药物与临床, 2018, 18(11): 1954-1956. [5] 高举. 全身麻醉复合硬膜外腔阻滞用于腹腔镜直肠癌根治术的效果观察[J]. 中国基层医药, 2018, 25(21): 2792-2795. doi: 10.3760/cma.j.issn.1008-6706.2018.21.018 [6] 赵力, 彭静, 周敏, 等. 全麻复合腰硬联合麻醉对低位直肠癌患者腹腔镜手术后时间及血清免疫球蛋白、C3水平变化的影响[J]. 广东医学, 2019, 40(4): 526-530. [7] 占霖森, 兰允平, 黄莉, 等. 全身麻醉复合硬膜外阻滞的麻醉方式在老年结直肠癌行腹腔镜手术患者中应用效果[J]. 中国临床保健杂志, 2019, 22(1): 60-63. doi: 10.3969/J.issn.1672-6790.2019.01.017 [8] XU Y J, SUN X, JIANG H, et al. Randomized clinical trial of continuous transversus abdominis plane block, epidural or patient-controlled analgesia for patients undergoing laparoscopic colorectal cancer surgery[J]. Br J Surg, 2020, 107(2): e133-e141. doi: 10.1002/bjs.11403
[9] 李红, 吴军娜, 刘叶, 等. 右美托咪定对不同年龄妇科腹腔镜手术患者围术期应激反应的影响[J]. 河北医科大学学报, 2019, 40(10): 1201-1206. doi: 10.3969/j.issn.1007-3205.2019.10.020 [10] 陈鹏, 陈伟, 张毅, 等. 不同剂量盐酸右美托咪定对骨科全麻手术病人升压效应的影响[J]. 蚌埠医学院学报, 2019, 44(11): 1490-1493. [11] 杨得振, 贾勇, 田博, 等. 当归补血汤对结直肠癌围手术期患者肠道菌群及机体免疫功能的影响[J]. 西部中医药, 2019, 32(11): 1-4. [12] 覃广业, 杨迎春, 周林荣, 等. 罗哌卡因复合舒芬太尼围手术期镇痛对直肠癌根治术患者免疫功能和血清肿瘤标志物的影响[J]. 河北医学, 2019, 25(2): 341-346. doi: 10.3969/j.issn.1006-6233.2019.02.045 [13] 王长明, 蔡长华, 张静, 等. 不同麻醉方法下腹腔镜结直肠癌手术麻醉恢复期效果的比较[J]. 实用医学杂志, 2018, 34(20): 3454-3457. doi: 10.3969/j.issn.1006-5725.2018.20.031 [14] 杨玲, 张春梅, 刘佳, 等. 全麻复合硬膜外阻滞对腹腔镜下结肠癌根治术患者循环功能、血清S100β蛋白水平和认知功能的影响[J]. 实用癌症杂志, 2020, 35(5): 833-836. doi: 10.3969/j.isn.1001-5930.2020.05.036 [15] 宋军民, 张炜, 米纪元, 等. 单吻合器双荷包吻合法在腹腔镜下低位直肠癌前切除术中的应用[J]. 郑州大学学报: 医学版, 2020, 55(1): 25-28. [16] ZHANG X, JIANG H. Application of sevoflurane inhalation combined with epidural anesthesia in patients with colorectal cancer and its effect on postoperative perceptual function[J]. Oncol Lett. 2019, 17(5): 4443-4448.
[17] 何永冠, 曹晓霞, 朱彬, 等. 全麻复合硬膜外麻醉对胃癌根治术患者应激反应、血流动力学及免疫功能影响分析[J]. 现代消化及介入诊疗, 2018, 23(5): 588-591. doi: 10.3969/j.issn.1672-2159.2018.05.014 [18] 齐英军, 冯英博. 全身麻醉复合硬膜外阻滞麻醉在腹腔镜手术治疗老年直肠癌中的应用效果及对应激反应的影响[J]. 癌症进展, 2020, 18(19): 2016-2018. -
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