地佐辛静脉麻醉联合罗哌卡因局部浸润麻醉在腹腔镜结直肠癌根治术患者恢复期应激反应的影响

摘要

目的:探讨地佐辛静注辅助罗哌卡因浸润麻醉对改善结直肠癌患者实施腹腔镜根治术后麻醉恢复期应激反应程度所起作用.方法:将98例择期实施腹腔镜根治术的结直肠癌患者均分为两组,对照组仅切皮前10min时用罗哌卡因进行浸润麻醉;观察组切皮前使用罗哌卡因,手术结束前0.5h静注地佐辛.观察两组患者麻醉药物使用量、麻醉恢复、拔管时间及麻醉恢复期躁动发生情况,麻醉前(T0)、手术结束(T1)、拔管后(T2)、拔管后10min(T3)及拔管0.5h(T4)时患者血糖(BG)及血浆中皮质醇(Cor)、白细胞介素-6(IL-6)、肾上腺素(E)、肿瘤坏死因子-α(TNF-α)水平变化.结果:与对照组相比,观察组患者舒芬太尼、丙泊酚使用量明显减少(P<0.05),麻醉恢复及拔管时间明显缩短(P<0.05),麻醉恢复期躁动发生率明显降低(P<0.05).与T0时相比,T1~T4时两组患者BG、血浆Cor、IL-6、E及TNF-α水平均明显升高(P<0.05),然此期间,观察组各项指标均明显低于对照组(P<0.05).结论:地佐辛静脉注射辅助罗哌卡因浸润麻醉可有效降低结直肠癌根治术中麻醉剂使用量,缓解患者麻醉恢复期应激反应程度,降低躁动发生率.%Objective:To investigate the effect of intravenous infusion of dezocine to ropivacaine for improving the degree of stress response in patients with colorectal cancer after laparoscopic radical mastectomy .Methods:A total of 98 patients undergoing laparoscopic radical resection of colorectal cancer were divided into two groups .The cases of the control group were infused with Ropivacaine only 10 minutes before skin incision .The patients in the observation group were treated with Ropivacaine only 10 minutes before skin incision ,and infused with Dezocine 0 . 5h before surgery .The deses of anaesthetic ,anesthesia recovery ,extubation time and agitation recovery during an-esthesia;Blood glucose (BG) ,plasma levels of Cortisol (Cor) ,interleukin-6 (IL-6) and Tumour necrosis factor-a (TNF-a) were measured before anesthesia (T0 ) ,at the end of operation (T1 ) ,after extubation (T2 ) ,10 min(T3 ) and 0 .5 h (T4 )after extubation .Results:Compared with the control group ,the doses of sufentanil and propofol consumption in the observation group was significantly decreased ,the time of anesthesia recovery and extubation was significantly shorter ,and the incidence of agitation during anesthesia recovery period was significantly lower (P<0 . 05 ) .Compared with T0 ,the levels of BG ,Co ,IL-6 ,E and TNF-a in both groups were significantly increased dur-ing T1 ~ T4 ;and during this period ,the indexes in observation group were significantly lower than those in control group ,it had statistically significant (P<0 .05) .Conclusion :Dezocine intravenous injection of Ropivacaine infiltra-tion anesthesia can effectively reduce the amount of anesthetics used in radical resection of colorectal cancer ,relieve the degree of stress response during anesthesia recovery ,and reduce the incidence of agitation .