无阿片保留自主呼吸在腹腔镜下食管癌根治术全身麻醉中的应用效果

doi:10.3760/cma.j.issn.1007-1245.2023.22.019

摘要/Abstract

摘要：

目的　观察无阿片保留自主呼吸在辅助腹腔镜下食管癌根治术全身麻醉中的应用效果。方法　选取2021年1月至2022年1月南阳医学高等专科学校第一附属医院收治的116例食管癌患者作为研究对象。入组患者均接受腹腔镜下根治术治疗。根据治疗方案和麻醉指征，将术中未应用阿片药镇痛的56例患者设为观察组［男30例，女26例，年龄（60.44±5.25）岁］，实施区域神经阻滞麻醉+无阿片保留自主呼吸的喉罩全身麻醉；将其余60例设为对照组［男35例，女25例，年龄（61.23±5.18）岁］，实施常规气管插管全身麻醉。比较两组临床指标、术前术后动脉血气指标、术后静息咳嗽时疼痛情况及不良反应发生情况。采用t检验和χ²检验。结果　观察组手术时间（232.45±50.33）min，对照组（216.37±50.26）min，差异无统计学意义（t=0.651，P>0.05）；观察组苏醒时间、术后首次下床时间、住院时间均短于对照组［（5.15±1.33）h比（6.72±1.32）h、（2.31±0.33）d比（3.76±1.28）d、（10.31±5.46）d比（13.49±5.11）d］，差异均有统计学意义（t=6.378、8.224、3.240，均P<0.05）。术前1 d，两组动脉血气指标差异均无统计学意义（均P>0.05）；术后1 d，观察组血氧饱和度（oxygen saturation of blood，SaO₂）高于对照组［（0.984 4±0.053 6）比（0.952 5±0.051 7）］，呼气末二氧化碳分压（partial pressure of end-tidal carbon dioxide，PETCO₂）、动脉二氧化碳分压（partial pressure，PaCO₂）低于对照组［（42.35±5.14）mmHg（1 mmHg=0.133 kPa）比（45.77±5.12）mmHg、（43.19±5.23）mmHg比（46.11±5.28）mmHg］，差异均有统计学意义（t=3.262、3.588、2.990，均P<0.05）。观察组术后静息时视觉模拟量表（Visual Analogue Scale，VAS）评分、咳嗽时VAS评分、不良反应发生率均低于对照组［（3.25±0.14）分比（4.49±0.32）分、（4.04±0.77）分比（5.63±1.28）分、5.36%（3/56）比16.67%（10/60）］，差异均有统计学意义（t=26.705、8.036，χ²=6.525，均P<0.05）。结论　无阿片保留自主呼吸的喉罩全身麻醉可加快腹腔镜下食管癌根治术患者术后苏醒、康复进程，对改善患者术后动脉血气指标、缓解术后疼痛、降低不良反应发生率均有积极意义。

关键词:

腹腔镜下食管癌根治术, , , 阿片类镇痛药, , , 间歇保留自主呼吸, , , 喉罩全麻, , , 神经阻滞技术

Abstract:

Objective　To observe the application effect of opioid free and autonomous respiration preservation in general anesthesia for laparoscopic radical esophagectomy. Methods　One hundred and sixteen patients with esophageal cancer admitted to First Hospital, Nanyang Medical College from January 2021 to January 2022 were selected as the study objects. All the enrolled patients underwent laparoscopic radical surgery. According to the treatment plans and anesthesia indications, the 56 patients who did not use opioid analgesics during surgery were set as an observation group [30 males and 26 females; (60.44±5.25) years old]; the regional nerve block anesthesia and laryngeal mask airway general anesthesia without opioid preservation of spontaneous breathing were performed. The rest 60 cases were set as a control group [35 males and 25 females; (61.23±5.18) years old]; the routine tracheal intubation general anesthesia was performed. The clinical indicators, arterial blood gas indicators before and after the surgery, pain during rest and when they coughed after surgery, and adverse reactions were compared between the two groups. t and χ² tests were applied. Results　The operation time of the observation group was slightly longer than that of the control group [(232.45±50.33) min vs. (216.37±50.26) min], with no statistical difference (t=0.651, P>0.05). The recovery time, the first time to get out of bed after surgery, and hospitalization time in the observation group were shorter than those in the control group [(5.15±1.33) h vs. (6.72±1.32) h, (2.31±0.33) d vs. (3.76±1.28) d, and (10.31±5.46) d vs. (13.49±5.11) d], with statistical differences (t=6.378, 8.224, and 3.240; all P<0.05). There were no statistical differences in the arterial blood gas indicators 1 d before the surgery between the two groups (all P>0.05). One day after the surgery, the oxygen saturation of blood (SaO₂), partial pressure of end-tidal carbon dioxide (PETCO₂), and partial pressure (PaCO₂) in the observation group were better than those in the control group [(0.984 4±0.053 6) vs. (0.952 5±0.051 7), (42.35±5.14) mmHg (1 mmHg=0.133 kPa) vs. (45.77±5.12) mmHg, and (43.19±5.23) mmHg vs. (46.11±5.28) mmHg], with statistical differences (t=3.262, 3.588, and 2.990; all P<0.05). The scores of Visual Analogue Scale (VAS) when they were at rest and coughed and the incidence of adverse reactions in the observation group were lower than those in the control group [(3.25±0.14) vs. (4.49±0.32), (4.04±0.77) vs. (5.63±1.28), and 5.36% (3/56) vs. 16.67% (10/60)], with statistical differences (t=26.705 and 8.036 and χ²=6.525; all P<0.05). Conclusion　Laryngeal mask general anesthesia without opioid and keeping spontaneous breathing can accelerate the recovery and rehabilitation process of patients after laparoscopic radical resection for esophageal cancer, and has positive significance in improving their arterial blood gas indicators after surgery, alleviating postoperative pain, and reducing the incidence of adverse reactions.

Key words:

Laparoscopic radical resection of esophageal cancer, , Opioid analgesics, , Intermittent retention of autonomous breathing, , Laryngeal mask anesthesia, Neuroblock technique

鲁思遥徐国亭李喜龙.

无阿片保留自主呼吸在腹腔镜下食管癌根治术全身麻醉中的应用效果 [J]. 国际医药卫生导报, 2023, 29(24): 3620-3624.

Lu Siyao, Xu Guoting, Li Xilong.

Application effect of opioid free and autonomous respiration preservation in general anesthesia for laparoscopic radical esophagectomy [J]. International Medicine and Health Guidance News, 2023, 29(24): 3620-3624.

参考文献

[1] Qiu MJ, Yang SL, Wang MM, et al. Prognostic evaluation of esophageal cancer patients with stages Ⅰ-Ⅲ [J]. Aging (Albany NY), 2020, 12(14): 14736-14753. DOI: 10.18632/aging.103532.
[2] 丁洁,黄大业,赵坚,等. 改良管状胃代替食管对胸腹腔镜下食管癌根治术患者肺功能及术后并发症的影响[J]. 癌症进展,2021,19(19):1999-2001. DOI:10.11877/j.issn.1672- 1535. 2021.19.19.16.
[3] 孙亚林,孙莉,李廷坤,等. 不同潮气量双肺通气辅以二氧化碳气胸在胸腹腔镜下食管癌根治术的应用效果[J]. 中华医学杂志,2021,101(35):2787-2791. DOI:10.3760/cma.j.cn112137-20210118-00158.
[4] 孙亚林,孙莉,李廷坤,等. 不同气管插管术在胸腹腔镜食管癌根治术中的应用[J]. 中华医学杂志,2021,101(9):630-635. DOI:10.3760/cma.j.cn112137-20200628- 01963.
[5] 张婷婷,焦冬欣,王彩平,等. 喉罩保留自主呼吸全麻在临床短小手术中的应用[J]. 中国实验诊断学,2022,26(3):454-458. DOI:10.3969/j.issn.1007-4287.2022.03.041.
[6] 许巧巧,熊娟,杨涛,等. 喉罩间断自主呼吸行McKeown食管癌根治术麻醉管理一例[J]. 临床麻醉学杂志,2019,35(6):617-618. DOI:10.12089/jca.2019.06.024.
[7] 杨日辉,范伟雄,刘恺怡,等. 多模态MRI联合超声内镜对食管癌术前T分期的诊断价值[J]. 实用放射学杂志,2021,37(8):1271-1274. DOI:10.3969/j.issn.1002-1671. 2021.08.012.
[8] Knuf KM, Manohar CM, Cummings AK. Addressing inter-rater variability in the ASA-PS classification system [J]. Mil Med, 2020, 185(5-6): e545-e549. DOI: 10.1093/milmed/usz433.
[9] 赫捷,陈万青,李兆申,等. 中国食管癌筛查与早诊早治指南(2022,北京)[J]. 中华消化外科杂志,2022,21(6):677-700. DOI:10.3760/cma.j.cn115610-20220517-00282.
[10] 张玉良,靳永欣,马银龙. 胸腔镜联合腹腔镜食管癌根治术和开胸三切口食管癌根治术治疗食管癌的效果分析[J]. 国际医药卫生导报,2018,24(1):29-31. DOI:10.3760/cma.j.issn.1007-1245.2018.01.009.
[11] Wang Y, Cheng J, Yang L, et al. Ropivacaine for intercostal nerve block improves early postoperative cognitive dysfunction in patients following thoracotomy for esophageal cancer [J]. Med Sci Monit, 2019, 25: 460-465. DOI: 10.12659/MSM.912328.
[12] 郭佳庆,王晓蕾,常海宽,等. 七氟烷后处理对单肺通气下行食管癌根治术患者肺损伤的影响[J]. 新乡医学院学报,2021,38(3):240-244. DOI:10.7683/xxyxyxb.2021.03.007.
[13] 程富兵,王治,邹法超. 单腔气管插管和双腔气管插管在胸腔镜食管癌根治术中的应用效果[J]. 安徽医学,2021,42(8):928-932. DOI:10.3969/j.issn.1000-0399.2021.08.025.
[14] 张欢欢,孟璐,姚晶曼,等. 胸椎旁神经阻滞复合保留自主呼吸的非气管插管麻醉在胸腔镜手术中应用的临床分析[J]. 现代医学,2022,50(1):70-74. DOI:10.3969/j.issn.1671- 7562.2022.01.013.
[15] 刘民强,吴强,洪凤珠,等. 无阿片保留自主呼吸麻醉技术在胸科日间手术中的应用现状[J]. 广东医学,2022,43(1):127-130. DOI:10.13820/j.cnki.gdyx.20204077.
[16] 高源,乔辉,刘鹏飞,等. 免充喉罩与气管内插管用于全身麻醉下经气管镜超声引导针吸活检的临床研究[J]. 中国内镜杂志,2022,28(5):7-13. DOI:10.12235/E20210475.
[17] 高安,杨成伟,孙丽娜,等. 椎旁神经阻滞与竖脊肌平面阻滞在腔镜食管癌根治术中镇痛作用的比较[J]. 国际麻醉学与复苏杂志,2021,42(8):823-827. DOI:10.3760/cma.j.cn321761-20201103-00347.
[18] 张军锋. 保留自主呼吸喉罩全身麻醉肺减容术对肺气肿患者气道炎症及不良反应的临床研究[J]. 中国药物与临床,2021,21(20):3421-3423. DOI:10.11655/zgywylc 2021.20.025.
[19] 徐小玉,吴兵,韩海娥. 食管癌组织PD-1及PD-L1表达对中晚期食管癌患者化疗近期疗效的影响[J]. 国际医药卫生导报,2020,26(3):370-373. DOI:10.3760/cma.j.issn.1007- 1245.2020.03.024.
[20] 刘静,苏冰莲,龚兰娟,等. 快速康复理念下多模式镇痛对食管癌患者术后疼痛控制效果的探讨[J]. 国际医药卫生导报,2022,28(3):341-344. DOI:10.3760/cma.j.issn.1007- 1245.2022.03.011.