新疆医科大学学报

目的探讨2种不同麻醉方式对快速康复外科(ERAS)结肠癌根治术患者术后炎症反应的影响。方法选取2016年1月-2017年1月在新疆维吾尔自治区人民医院普通外科行结肠癌根治术患者100例,随机分为观察组和对照组,每组50例。观察组采用全身麻醉联合硬膜外麻醉的麻醉方式,对照组采用单纯全身麻醉的麻醉方式。比较2组患者麻醉诱导前30min(T₀)、手术进行2h(T₁)、手术结束后3h(T₂)、手术结束后6h(T₃)、术后24h(T₄)、术后48h(T₅)时血清白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白介素-10(IL-10)水平。比较2组术后恢复情况,包括疼痛视觉模拟评分(VAS评分)、术后首次肛门排气时间、首次排便时间、下床活动时间。结果 2组患者术前各项指标差异均无统计学意义(P>0.05);2组患者T₀时刻IL-6、TNF-α、CRP、IL-10的水平相比较差异无统计学意义(P>0.05);观察组患者T₁、T₂、T₃、T₄、T₅时刻IL-6、TNF-α、CRP、IL-10的水平与对照组水平相比较低,差异有统计学意义(P<0.05);观察组患者的术后VAS评分、首次肛门排气时间、首次排便时间、下床活动时间及住院天数明显低于对照组(P值均<0.05)。结论快速康复外科结肠癌根治术患者应用全身麻醉复合硬膜外的麻醉方式,可以降低患者术后炎症因子的水平,从而减轻术后炎症反应,是快速康复外科结肠癌根治术患者行之有效的麻醉方法。

Objective To investigate the effects of conventional general anesthesia or combined with epidural anesthesia on inflammatory response undergoing radical operation for colon cancer.Methods A hundred patients undergoing radical colon cancer operation in Xinjang Region People's Hospital were randomly divided into the epidural anesthesia combined general anesthesia group and the general anesthesia group with50 cases in each.Venous blood samples were taken before induction of anesthesia(T0),2 hours after operation carrying on(T1),3 hours after operation(T2),6 hours after operation(T3),24 hours after operation(T4)and 48 hours after operation(T5).Serum interleukin-6(IL-6),tumor necrosis factor alpha(TNF-α),C reactive protein(CRP)and interleukin-10(IL-10)was tested by enzyme-linked immunoassay(ELISA).Postoperative recovery situation between two groups was compared,including visual analog scale(VAS),the first anal exhaust time,the first defecations time and ambulant time after surgery.Results There was no significant difference about general condition between the two groups before operation(P >0.05);there was no significant difference between the two groups of patients in the level of IL-6,TNF-α,CRP and IL-10 at T0(P >0.05);compared with the control group,the levels of IL-6,TNF-α,CRP and IL-10 in the observed group at T1~T5 time were significantly decreased(P <0.05).And the first anal exhaust time,the first defecations time,ambulant time were also significantly lower after the surgery than those in the control group(P <0.05).Conclusion General anesthesia combined with epidural anesthesia in patients undergoing radical operation for colon cancer can effectively reduce postoperative inflammatory indexes and reduce inflammatory response,which is more advantageous to patients.