2021 年第 6 期 第 16 卷

基于加速康复外科的联合麻醉方案对肝肿瘤手术患者应激反应的影响

Effect of combined anesthesia schemes based on enhanced recovery after surgery on stress response of patients undergoing liver tumor surgery

作者：吴宪宏1刘殿刚2卿恩明1

英文作者：Wu Xianhong1 Liu Diangang2 Qing Enming1

单位：1首都医科大学附属北京安贞医院麻醉中心100029；2首都医科大学宣武医院普外科100053

英文单位：1Anesthesia Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of General Surgery Xuanwu Hospital Capital Medical University Beijing 100053 China

关键词：肝肿瘤；加速康复；联合麻醉；应激反应；全身麻醉；儿茶酚胺

英文关键词：Livertumor;Enhancedacceleratedrecovery;Combinedanesthesia;Stressresponse;Generalanesthesia;Catecholamines

• 摘要：

• 目的 观察基于加速康复外科的2种联合麻醉方案对肝肿瘤手术患者应激反应的影响。方法 选取2019年1月至2021年1月于首都医科大学附属北京安贞医院实施开腹早期肝肿瘤手术的128例患者纳入研究，按照随机数字表法将患者分为对照组和观察组，各64例。对照组实施气管插管全身麻醉联合腹横筋膜阻滞；观察组实施气管插管全身麻醉联合硬膜外麻醉。比较2组的手术参数、生命体征指标、麻醉优良率、应激反应指标、不良反应发生率、术后麻醉苏醒情况和手术前后认知功能评分。结果 观察组与对照组手术时间、出血量及插管前和拔管后收缩压、舒张压、心率及麻醉优良率比较，差异均无统计学意义（均P>0.05）。2组拔管后肾上腺素、去甲肾上腺素、多巴胺水平均较插管前升高，但观察组均低于对照组［（203±5）pmol/L比（211±6）pmol/L、（653±7）pmol/L比（663±8）pmol/L、（543±8）nmol/L比（554±9）nmol/L］，差异均有统计学意义（均P<0.05）。2组寒战、恶心呕吐、躁动发生率差异均无统计学意义（均P>0.05）。术后观察组自主呼吸恢复时间、睁眼时间、指令恢复时间均短于对照组，差异均有统计学意义（均P<0.05）。2组术后简易精神状态检查量表、蒙特利尔认知评估量表评分均低于术前，但观察组均高于对照组，差异均有统计学意义（均P<0.05）。结论 基于加速康复外科的联合麻醉方案在肝肿瘤手术中具有良好的麻醉效果，其中联合硬膜外麻醉的方案相比神经阻滞更佳，可减轻应激反应，减少儿茶酚胺分泌，患者术后恢复更快。

• Objective To observe the effect of two combined anesthesia schemes based on enhanced recovery after surgery(ERAS) on stress response of patients undergoing liver tumor surgery. Methods From January 2019 to January 2021, 128 patients who underwent early primary liver tumor resection in Beijing Anzhen Hospital, Capital Medical University were included in the study, and the patients were randomly divided into two groups(n=64 in each group) according to random number table method. In the control group, general anesthesia with tracheal intubation combined with transversal abdominal fascial nerve block was performed, and in the observation group, general anesthesia with tracheal intubation combined with epidural analgesia was performed. The operative parameters, vital signs indexes, excellent rate of anesthesia, stress reaction indexes, incidence of adverse reactions, postoperative anesthesia awakening and cognitive function scores before and after operation were compared between the two groups. Results There were no significant differences in operative time, bleeding volume, systolic blood pressure and diastolic blood pressure before intubation and after extubation, heart rate and the excellent and good rate of anesthesia between the observation group and the control group(all P>0.05). After extubation, the levels of epinephrine, norepinephrine and dopamine in the two groups were higher than those before intubation, but the levels in the observation group were lower than those in the control group［（203±5）pmol/L vs （211±6）pmol/L, （653±7）pmol/L vs （663±8）pmol/L, （543±8）nmol/L vs （554±9）nmol/L］, and the differences were statistically significant(all P<0.05). There were no significant differences in the incidences of shivering, nausea, vomiting and agitation between the two groups(all P>0.05). The recovery time of spontaneous breathing, eye opening and command in the observation group were shorter than those in the control group(all P<0.05). The scores of mini mental state examination scale and Montreal cognitive assessment scale in the two groups after operation were lower than those before operation, but those in the observation group were higher than those in the control group, and the differences were statistically significant(all P<0.05). Conclusion The combined anesthesia scheme based on ERAS has good anesthetic effect in liver tumor surgery, in which the combined epidural anesthesia scheme is better compared with nerve block, which can reduce stress response, decrease catecholamine secretion, and patients recover faster after surgery.