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

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