硬膜外复合静脉全身麻醉在老年腹腔镜结肠癌根治术患者中的应用效果及其对肺功能的影响研究

摘要

Objective To investigate The effect of epidural combined with general anesthesia in older patients undergoing laparoscopic radical resection for colonic cancer and its effect on lung function. Methods 92 patients undergoing laparoscopic resection of colon cancer in our hospital were randomly assigned to treatment group (epidural anesthesia combined with intravenous anesthesia) and control group (intravenous anesthesia), with 46 patients in each group. The effects of anesthesia, sevoflurane inhalation concentration, postoperative rehabilitation index and lung function index were recorded. The incidence of pulmonary infection was recorded. Results There was no difference in anesthesia induction time, anesthesia duration, breathing time, extubation time of recovery between the two groups (P ＞ 0.05). Time to recovery was shorter in treatment group than the control group (P ＜ 0.05). The average inhalation concentration of sevoflurane was (1.54 ± 0.32)％ in treatment group, which was lower than that in control group (P ＜0.05). The anal exhaust time, feeding time, extubation time, catheter removal time and length of stay were shorter in the treatment group than in the control group (P ＜ 0.05). 3 and 7 days after operation, FVC, FEV1 and MVV in both groups were lower than those preoperative levels, and they were higher in the treatment group than in the control group (P ＜ 0.05). The incidence of pulmonary infection was lower in the treatment group than that in the control group (P ＜ 0.05). Conclusion Epidural combined with intravenous general anesthesia can shorten the time to recovery, reduce the dosage of sevoflurane, the lung function damage, and the incidence of pulmonary infection, and promote the rehabilitation. The clinical application value is high.%目的 探讨硬膜外复合静脉全身麻醉在老年腹腔镜结肠癌根治术患者中的应用效果及其对患者肺功能的影响.方法 将本院92例老年腹腔镜结肠癌根治术患者随机分为观察组(硬膜外复合静脉全身麻醉)与对照组(静脉全身麻醉),每组各46例.比较两组麻醉效果、七氟醚吸入浓度、术后康复指标及最大自主通气量(MVV)、用力肺活量(FVC)和第一秒用力呼气量(FEV1)变化,记录肺部感染发生率.结果 两组麻醉诱导时间、麻醉维持时间、自主呼吸恢复时间、拔除气管导管时间差异均无统计学意义(均P ＞ 0.05);观察组苏醒时间短于对照组(P ＜ 0.05).观察组七氟醚平均吸入浓度(1.54±0.32) ％,对照组七氟醚平均吸入浓度(2.67±0.45) ％,观察组七氟醚平均吸入浓度低于对照组,差异有统计学意义(P ＜ 0.05).观察组肛门排气时间、进食时间、引流管拔除时间、拔除尿管时间、住院时间均短于对照组,差异均有统计学意义(均P ＜ 0.05).两组术后3 d、术后7 d FVC、FEV1、MVV均低于术前1 d,观察组高于对照组,差异均有统计学意义(均P ＜ 0.05).观察组肺部感染发生率低于对照组,差异有统计学意义(P＜ 0.05).结论 硬膜外复合静脉全身麻醉可减少七氟醚用量,缩短苏醒时间,促进患者康复,减轻肺功能损伤,降低肺部感染发生率,临床应用价值较高.