切换至 "中华医学电子期刊资源库"

中华普通外科学文献(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 120 -124. doi: 10.3877/cma.j.issn.1674-0793.2021.02.009

所属专题: 文献

论著

瑞芬太尼联合硬膜外麻醉在胃癌根治术中的应用及对血流动力学的影响
陈健1,(), 李成洁1   
  1. 1. 571700 儋州,海南西部中心医院麻醉科
  • 收稿日期:2020-05-22 出版日期:2021-04-01
  • 通信作者: 陈健
  • 基金资助:
    海南省自然科学基金面上项目(819MS126)

Effect of remifentanil combined with epidural anesthesia on hemodynamics in patients with radical gastrectomy

Jian Chen1,(), Chengjie Li1   

  1. 1. Department of Anesthesiology, Hainan Western Central Hospital, Danzhou 571700, China
  • Received:2020-05-22 Published:2021-04-01
  • Corresponding author: Jian Chen
引用本文:

陈健, 李成洁. 瑞芬太尼联合硬膜外麻醉在胃癌根治术中的应用及对血流动力学的影响[J/OL]. 中华普通外科学文献(电子版), 2021, 15(02): 120-124.

Jian Chen, Chengjie Li. Effect of remifentanil combined with epidural anesthesia on hemodynamics in patients with radical gastrectomy[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(02): 120-124.

目的

研究瑞芬太尼联合硬膜外麻醉在胃癌根治术中的应用效果以及对患者血流动力学的影响。

方法

选取2018年1月至2019年12月海南西部中心医院收治的100例行胃癌D2根治手术的患者作为研究对象。按照麻醉方式不同分为两组,各50例。联合组采用瑞芬太尼联合硬膜外麻醉,对照组仅行全身麻醉。比较两组患者手术相关指标、血流动力学指标、应激反应指标、出室前Steward苏醒评分、术后24 h疼痛评分(VAS)及并发症发生情况。

结果

联合组丙泊酚、瑞芬太尼用量少于对照组,拔管时间、苏醒时间优于对照组(P<0.05);两组手术时间、术中出血量、术中输液量及各时间点麻醉深度指数(CSI)差异无统计学意义。两组心率(HR)、平均动脉压(MAP)、收缩压(SBP)、舒张压(DBP)麻醉前差异均无统计学意义,但麻醉后60 min、拔管后10 min时联合组明显低于对照组(P<0.05)。术后3、7 d时联合组应激指标皮质醇(Cor)、去甲肾上腺素(Ne)、总抗氧化能力(TAC)水平明显低于对照组(P<0.05)。联合组Steward苏醒评分及术后24 h VAS评分均优于对照组(P<0.05)。

结论

瑞芬太尼联合硬膜外麻醉应用于胃癌根治术能够促进患者苏醒,维持患者术中血流动力学稳定,降低应激反应,缓解术后疼痛,安全可行,可在临床推广。

Objective

To investigate the effect of remifentanil combined with epidural anesthesia in radical gastrectomy for gastric cancer and its effect on hemodynamics.

Methods

A total of 100 patients undergoing radical gastrectomy D2 in Hainan Western Central Hospital from January 2018 to December 2019 were selected as study subjects. They were divided into two groups according to different anesthesia methods: the combination group was given remifentanil combined with epidural anesthesia, while the control group was given general anesthesia only. The operative indicators, hemodynamic indicators, stress response indicators, Steward recovery score before ventricle, pain score 24 h after surgery and complications were compared between the two groups.

Results

The dosage of propofol and remifentanil in the combination group was less than that in the control group, and the extubation time and wake time was better than those in the control group (P<0.05). There were no statistically significant differences in operative time, intraoperative blood loss, intraoperative infusion volume, and cerebral state index (CSI) at each time point between the two groups. There were no statistically significant differences in HR, MAP, SBP and DBP between the two groups before anesthesia. HR, MAP, SBP and DBP in the combination group were significantly lower than those in the control group at 60 min after anesthesia and 10 min after extubation (P<0.05). At 3 d and 7 d postoperatively, the levels of Cor, Ne and TAC in the combination group were significantly lower than those in the control group (P<0.05). Steward recovery score and VAS score 24 h after surgery in the combination group were better than those in the control group (P<0.05).

Conclusions

The application of remifentanil combined with epidural anesthesia in radical gastrectomy for gastric cancer patients can promote patients’ recovery, maintain the intraoperative hemodynamic stability, reduce stress response, and relieve postoperative pain. It is safe and feasible, and can be promoted in clinical practice.

表1 100例胃癌根治术患者手术相关指标比较(±s
表2 100例胃癌根治术患者术中各时间点麻醉深度指数(CSI)比较(±s
表3 100例胃癌根治术患者术中血流动力学指标比较(±s
表4 100例胃癌根治术患者应激反应指标比较(±s
[1]
陈仁军,沈学用,倪辉,等. 舒芬太尼与瑞芬太尼各自复合丙泊酚静脉麻醉在腹腔镜胆囊切除术的效果比较[J]. 中国普通外科杂志,2018,27(8): 1041-1047.
[2]
Zhang L, Chen C, Wang L,et al. Awakening from anesthesia using propofol or sevoflurane with epidural block in radical surgery for senile gastric cancer[J]. Int J Clin Exp Med,2015,8(10): 19412-19417.
[3]
李毅,张雪霞,周少朋. 地佐辛与咪达唑仑复合瑞芬太尼用于肝癌射频消融术患者麻醉效果的比较[J/CD]. 中华普通外科学文献(电子版), 2017, 11(4): 236-238.
[4]
Bray F, Ferlay J, Soerjomataram I,et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin,2018,68(6): 394-424.
[5]
宋杰,陈凤格,赵伟,等. 胃癌的发病率现状与治疗研究进展[J]. 中国慢性病预防与控制,2016,24(9): 704-707.
[6]
葛宏升,周军,魏海梁. 全腹腔镜、腹腔镜辅助与开腹胃癌根治术治疗Ⅱ、Ⅲ期胃癌的疗效对比[J/CD]. 中华普通外科学文献(电子版), 2019, 13(2): 143-147.
[7]
刘孝国,孙建良. 阿片类药物诱发痛觉过敏与术后慢性疼痛的研究进展[J]. 国际麻醉学与复苏杂志,2018,39(11): 1086-1090.
[8]
徐江宁,张晓峰,徐美英,等. 硬膜外阻滞对全麻下肺癌根治术患者术后远期生活质量的影响[J]. 中华麻醉学杂志,2018,38(7): 833-836.
[9]
姚远,武永生,朱红霞,等. 硬膜外阻滞复合静脉全麻对乳腺癌根治术患者应激反应及T淋巴细胞亚群的影响[J]. 海南医学院学报, 2017, 23(18): 2562-2565.
[10]
王梅芳,濮健峰,任建刚,等. 右美托咪定或丙泊酚全麻复合硬膜外麻醉对胃癌根治术老年患者免疫功能的影响[J]. 临床麻醉学杂志,2016,32(11): 1094-1096.
[11]
Harris T, Kerry SM, Victor CR,et al. Application of lidocaine combined with parecoxib in elderly patients undergoing laparoscopic radical resection for colon cancer[J].World Chinese J Digestol,2014,384(14): S3.
[12]
时敬峰,韩景田,孙超,等. 全麻复合硬膜外麻醉对胃癌根治术患者应激及炎性反应的影响[J]. 中华肿瘤防治杂志,2016,23(S1): 135-136.
[13]
Li Y, Wang B, Zhang LL,et al. Dexmedetomidine combined with general anesthesia provides similar intraoperative stress response reduction when compared with a combined general and epidural anesthetic technique[J]. Anesth Analg,2016,122(4): 1202-1210.
[14]
Zhao J, Mo H. The impact of different anesthesia methods on stress reaction and immune function of the patients with gastric cancer during peri-operative period[J]. J Med Assoc Thai,2015,98(6): 568-573.
[15]
Pei L, Tan G, Wang L,et al. Comparison of combined general-epidural anesthesia with general anesthesia effects on survival and cancer recurrence: A Meta-analysis of retrospective and prospective studies[J]. PLoS One,2014,9(12): e114667.
[16]
刘廷琮. 不同麻醉方案对胃癌手术患者苏醒期躁动及认知功能的影响[J]. 中国老年学杂志, 2017, 37(3): 664-666.
[17]
陈波,彭文勇,屠文龙,等. 右美托咪定对腹腔镜胃癌根治术患者氧化应激、糖代谢及术后镇痛的影响[J]. 中华全科医学, 2018, 16(3): 395-397, 451.
[1] 宋玟焱, 杜美君, 陈佳丽, 石冰, 黄汉尧. 唇腭裂手术围手术期疼痛管理的研究进展及基于生物材料治疗新方法的展望[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(06): 397-405.
[2] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[3] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[4] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[5] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[6] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[7] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[8] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[9] 陈浩, 王萌. 胃印戒细胞癌的临床病理特征及治疗选择的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 108-111.
[10] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[11] 刘海旺, 施海, 尚利峰. 不同吻合器在腹腔镜远端胃癌根治术Roux-en-Y式吻合中的应用对比[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 643-646.
[12] 许杰, 李亚俊, 冯义文. SOX新辅助化疗后腹腔镜胃癌D2根治术与常规根治术治疗进展期胃癌的近期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 647-650.
[13] 杜伟, 廖土明, 李雄才, 关刚强, 何燊, 吴佳桥, 朱和荣. 2%利多卡因凝胶和润滑剂凝胶在女性尿流动力学检查中应用的随机对照研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 613-617.
[14] 谢浩文, 丁建英, 刘小霞, 冯毅, 姚婧. 椎旁神经阻滞对微创胃切除肥胖患者术中血流、术后应激及康复质量的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 569-573.
[15] 张立俊, 孙存杰, 胡春峰, 孟冲, 张辉. MSCT、DCE-MRI 评估术前胃癌TNM 分期的准确性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 519-523.
阅读次数
全文


摘要