張媛

【摘要】 目的 探究全身麻醉聯(lián)合硬膜外麻醉在直腸癌根治術中的麻醉療效。方法 80例擬行直腸癌根治術患者， 按隨機數(shù)字表法分為聯(lián)合組與全麻組， 各40例。全麻組實施全身麻醉， 聯(lián)合組實施全身麻醉聯(lián)合硬膜外麻醉。比較兩組喉罩拔出前及喉罩拔出1、5 min Richmond躁動-鎮(zhèn)靜評分， 蘇醒時間， 麻醉前及麻醉后5 min 動脈血二氧化碳分壓（PaCO2）、氧合指數(shù)（PaO2/FiO2）， 并發(fā)癥發(fā)生情況。結果 喉罩拔出前， 兩組Richmond躁動-鎮(zhèn)靜評分比較， 差異無統(tǒng)計學意義（P>0.05）;喉罩拔出1、5 min， 聯(lián)合組Richmond躁動-鎮(zhèn)靜評分顯著低于全麻組， 差異有統(tǒng)計學意義（P<0.05）;聯(lián)合組蘇醒時間（8.43±0.86）min顯著短于全麻組的（16.49±1.27）min， 差異有統(tǒng)計學意義（P<0.05）。麻醉前， 兩組PaCO2、PaO2/FiO2比較差異無統(tǒng)計學意義（P>0.05）;麻醉后5 min， 聯(lián)合組PaCO2顯著低于全麻組， PaO2/FiO2顯著高于全麻組， 差異有統(tǒng)計學意義（P<0.05）。聯(lián)合組并發(fā)癥發(fā)生率10.00%顯著低于全麻組的35.00%， 差異有統(tǒng)計學意義（P<0.05）。結論 將全身麻醉聯(lián)合硬膜外麻醉應用于直腸癌根治術中， 患者應激反應小， 蘇醒時間短， 并發(fā)癥少， 此方法值得應用與推廣。

【關鍵詞】 直腸癌根治術;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.