• 1.四川省巴中市中心醫(yī)院麻醉科(四川巴中 636000);;
  • 2.四川大學(xué)華西醫(yī)院胃腸外科中心(四川成都 610041);

目的  探討硬膜外麻醉復(fù)合全身麻醉用于直腸癌根治術(shù)的麻醉效果。
方法  本研究回顧性納入2010年6月至2012年6月期間在巴中市中心醫(yī)院接受直腸癌根治術(shù)并符合本研究納入條件的直腸癌患者共178例,其中男84例,女94例;年齡34~72歲,(51.9±10.255)歲;按麻醉方式分為單純?nèi)砺樽斫M(93例)和硬膜外麻醉復(fù)合全身麻醉組(85例),觀察2組的麻醉效果及不良反應(yīng)。
結(jié)果  2組一般基線資料比較,差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。2組的麻醉效果比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。從麻醉不良反應(yīng)來看,硬膜外麻醉復(fù)合全身麻醉組在高血壓、低血壓、心動過速及術(shù)后惡心嘔吐發(fā)生率方面均明顯低于單純?nèi)砺樽斫M(P<0.05),2組在心動過緩、室性早搏發(fā)生率及胃腸道恢復(fù)時(shí)間方面比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05),2組均無下肢神經(jīng)功能異常發(fā)生。
結(jié)論  硬膜外麻醉復(fù)合全身麻醉用于直腸癌根治術(shù)與單純?nèi)砺樽硐啾龋粌H能取得相同的麻醉效果,在減少麻醉不良反應(yīng)方面也具有明顯優(yōu)勢。

引用本文: 譚興中,岳永猛,汪曉東. 硬膜外麻醉復(fù)合全身麻醉用于直腸癌根治手術(shù)麻醉效果觀察. 中國普外基礎(chǔ)與臨床雜志, 2013, 20(8): 905-909. doi: 復(fù)制

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9. Gouvas N, Gogos-Pappas G, Tsimogiannis K, et al. Implementation of fast-track protocols in open and laparoscopic sphincter-preserving rectal cancer surgery:a multicenter, comparative, prospective, non-randomized study[J]. Dig Surg, 2012, 29(4):301-309.
10. Tsui BC, Rashiq S, Schopflocher D, et al. Epidural anesthesia and cancer recurrence rates after radical prostatectomy[J]. Can J Anaesth, 2010, 57(2):107-112.
11. Holte K, Foss NB, Svensén C, et al. Epidural anesthesia, hypotension, and changes in intravascular volume[J]. Anesthesiology, 2004, 100(2):281-286.
12. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery[J]. Lancet, 2003, 362(9399):1921-1928.
13. Gupta A, Björnsson A, Fredriksson M, et al. Reduction in mortality after epidural anaesthesia and analgesia in patients undergoing rectal but not colonic cancer surgery:a retrospective analysis of data from 655 patients in central Sweden[J]. Br J Anaesth, 2011, 107(2):164-170.
14. Sala C, García-Granero E, Molina MJ, et al. Effect of epidural anesthesia on colorectal anastomosis:a tonometric assessment[J]. Dis Colon Rectum, 1997, 40(8):958-961.
15. Ricaurte L, Vargas J, Lozano E, et al. Anesthesia and kidney transplantation[J]. Transplant Proc, 2013, 45(4):1386-1391.
16. Monaco F, Biselli C, Landoni G, et al. Thoracic epidural anesth-esia improves early outcome in patients undergoing cardiac surgeryfor mitral regurgitation:a propensity-matched study[J]. J Cardio-thorac Vasc Anesth, 2013, 27(3):445-450.
17. Tzimas P, Prout J, Papadopoulos G, et al. Epidural anaesthesia and analgesia for liver resection[J]. Anaesthesia, 2013, 68(6):628-635.
18. Binczak M, Tournay E, Billard V, et al. Major abdominal surgeryfor cancer:Does epidural analgesia have a long-term effect on recurrence-free and overall survival?[J]. Ann Fr Anesth Reanim,.
19. Okutani H, Okutani R, Nakamura T. Asystole developed during total gastrectomy under general anesthesia combined with thoracic epidural anesthesia[J]. Osaka City Med J, 2012, 58(2):83-86.
20. Panaretou V, Siafaka I, Theodorou D, et al. Combined general-epidural anesthesia with continuous postoperative epidural analgesiapreserves sigmoid colon perfusion in elective infrarenal aorticaneurysm repair[J]. Saudi J Anaesth, 2012, 6(4):373-379.
21. Claeys MA, Gepts E, Camu F. Haemodynamic changes duringanaesthesia induced and maintained with propofol[J]. Br J Anaesth, 1988, 60(1):3-9.
22. Naito Y, Tamai S, Shingu K, et al. Responses of plasma adrenocorticotropic hormone, cortisol, and cytokines during and after upper abdominal surgery[J]. Anesthesiology, 1992, 77(3):426-431.
23. Adams MC, Fifer MA, Jiang Y. New-onset left bundle branch block immediately following noncardiac surgery under combined general and epidural anesthesia[J]. J Anesth, 2013, 12(5):11-26.
24. Ezhevskaya AA, Mlyavykh SG, Anderson DG. The effects of continuous epidural anesthesia and postoperative epidural analgesiaon pain management and stress response in patients undergoing major spinal surgery[J]. Spine (Phila Pa 1976), 2013, 41(8):351-369.
25. , 32(5):e81-e88.
  1. 1. Arain MR, Buggy DJ. Anaesthesia for cancer patients[J]. Curr Opin Anaesthesiol, 2007, 20(3):247-253.
  2. 2. Gottschalk A, Ford JG, Regelin CC, et al. Association between epidural analgesia and cancer recurrence after colorectal cancer surgery[J]. Anesthesiology, 2010, 113(1):27-34.
  3. 3. Ahlers O, Nachtigall I, Lenze J, et al. Intraoperative thoracic epidural anaesthesia attenuates stress-induced immunosuppression in patients undergoing major abdominal surgery[J]. Br J Anaesth, 2008, 101(6):781-787.
  4. 4. 劉展, 汪曉東, 李立. 結(jié)直腸外科快速流程內(nèi)容及依據(jù)[J]. 中國普外基礎(chǔ)與臨床雜志, 2007, 14(4):469-473.
  5. 5. Wilmore DW, Kehlet H. Management of patients in fast track surgery[J]. BMJ, 2001, 322(7284):473-476.
  6. 6. 李立, 汪曉東, 舒曄, 等. 四川大學(xué)華西醫(yī)院肛腸外科·結(jié)直腸外科快速流程臨床指南(一)[J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(5):413.
  7. 7. Kremer M, Ulrich A, Büchler MW, et al. Fast-track surgery:the Heidelberg experience[J]. Recent Results Cancer Res, 2005, 165:14-20.
  8. 8. Langelotz C, Spies C, Müller JM, et al. “Fast-track”-rehabilitation in surgery, a multimodal concept[J]. Acta Chir Belg, 2005, 105(6):555-559.
  9. 9. Gouvas N, Gogos-Pappas G, Tsimogiannis K, et al. Implementation of fast-track protocols in open and laparoscopic sphincter-preserving rectal cancer surgery:a multicenter, comparative, prospective, non-randomized study[J]. Dig Surg, 2012, 29(4):301-309.
  10. 10. Tsui BC, Rashiq S, Schopflocher D, et al. Epidural anesthesia and cancer recurrence rates after radical prostatectomy[J]. Can J Anaesth, 2010, 57(2):107-112.
  11. 11. Holte K, Foss NB, Svensén C, et al. Epidural anesthesia, hypotension, and changes in intravascular volume[J]. Anesthesiology, 2004, 100(2):281-286.
  12. 12. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery[J]. Lancet, 2003, 362(9399):1921-1928.
  13. 13. Gupta A, Björnsson A, Fredriksson M, et al. Reduction in mortality after epidural anaesthesia and analgesia in patients undergoing rectal but not colonic cancer surgery:a retrospective analysis of data from 655 patients in central Sweden[J]. Br J Anaesth, 2011, 107(2):164-170.
  14. 14. Sala C, García-Granero E, Molina MJ, et al. Effect of epidural anesthesia on colorectal anastomosis:a tonometric assessment[J]. Dis Colon Rectum, 1997, 40(8):958-961.
  15. 15. Ricaurte L, Vargas J, Lozano E, et al. Anesthesia and kidney transplantation[J]. Transplant Proc, 2013, 45(4):1386-1391.
  16. 16. Monaco F, Biselli C, Landoni G, et al. Thoracic epidural anesth-esia improves early outcome in patients undergoing cardiac surgeryfor mitral regurgitation:a propensity-matched study[J]. J Cardio-thorac Vasc Anesth, 2013, 27(3):445-450.
  17. 17. Tzimas P, Prout J, Papadopoulos G, et al. Epidural anaesthesia and analgesia for liver resection[J]. Anaesthesia, 2013, 68(6):628-635.
  18. 18. Binczak M, Tournay E, Billard V, et al. Major abdominal surgeryfor cancer:Does epidural analgesia have a long-term effect on recurrence-free and overall survival?[J]. Ann Fr Anesth Reanim,.
  19. 19. Okutani H, Okutani R, Nakamura T. Asystole developed during total gastrectomy under general anesthesia combined with thoracic epidural anesthesia[J]. Osaka City Med J, 2012, 58(2):83-86.
  20. 20. Panaretou V, Siafaka I, Theodorou D, et al. Combined general-epidural anesthesia with continuous postoperative epidural analgesiapreserves sigmoid colon perfusion in elective infrarenal aorticaneurysm repair[J]. Saudi J Anaesth, 2012, 6(4):373-379.
  21. 21. Claeys MA, Gepts E, Camu F. Haemodynamic changes duringanaesthesia induced and maintained with propofol[J]. Br J Anaesth, 1988, 60(1):3-9.
  22. 22. Naito Y, Tamai S, Shingu K, et al. Responses of plasma adrenocorticotropic hormone, cortisol, and cytokines during and after upper abdominal surgery[J]. Anesthesiology, 1992, 77(3):426-431.
  23. 23. Adams MC, Fifer MA, Jiang Y. New-onset left bundle branch block immediately following noncardiac surgery under combined general and epidural anesthesia[J]. J Anesth, 2013, 12(5):11-26.
  24. 24. Ezhevskaya AA, Mlyavykh SG, Anderson DG. The effects of continuous epidural anesthesia and postoperative epidural analgesiaon pain management and stress response in patients undergoing major spinal surgery[J]. Spine (Phila Pa 1976), 2013, 41(8):351-369.
  25. 25. , 32(5):e81-e88.