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罗哌卡因浸润麻醉联合地佐辛静脉麻醉对中老年食管癌手术患者麻醉恢复期的影响
高慧,高洁,罗志锴
0
(延安大学附属医院麻醉科)
摘要:
【摘要】目的 探讨罗哌卡因浸润麻醉联合地佐辛静脉麻醉对中老年食管癌手术患者麻醉恢复期的影响。方法 选择2012年1月~2015年12月住院择期行中老年食管癌根治术患者120例,采用完全随机法将患者分为四组:A组(对照组)、B组(地佐辛组)、C组(罗哌卡因组)和D组(罗哌卡因联合地佐辛组),每组各30例。观察并比较各组患者的基线资料、血流动力学变化、不同时点血糖、血浆皮质醇(Cor)、肾上腺素(E)和去甲肾上腺素(NE)浓度变化、麻醉恢复期间躁动和高血压发生率及不良反应的发生情况。结果 四组患者性别、年龄、体质量及美国麻醉医师协会(ASA)分级等基线资料比较差异无统计学意义(P>0.05);在T3时段,A、B和C三组患者舒张压(DBP)显著升高,心率(HR)显著增快(P均<0.05);D组患者DBP显著低于其余三组,HR显著慢于其余三组(P均<0.05);四组患者在T1~T4时段血糖、Cor、E和NE均显著升高(P均<0.05)。与A组比较,B组、C组和D组T1~T4时段血糖、Cor、E和NE浓度显著降低(P均<0.05);与B组和C组比较,D组T1~T4时段血糖、Cor、E和NE浓度显著降低(P均<0.05);B组、C组和D组患者躁动和高血压发生率均显著低于A组(P均<0.05);D组患者躁动和高血压发生率均显著低于B组和C组(P均<0.05);四组均未发生呼吸抑制、头晕头痛、咽喉疼痛和嗜睡等不良反应。结论 罗哌卡因和地佐辛联合应用可有效减少中老年食管癌手术患者术后应激反应的发生,有利于患者血流动力学状态的稳定,可在临床推广应用。
关键词:  罗哌卡因  地佐辛  麻醉  躁动  心血管反应
DOI:
基金项目:陕西省科学技术研究发展计划项目
Effect of ropivacaine infusion anesthesia combined with intravenous dexamethasone on recovery of anesthesia in middle and aged patients with esophageal carcinoma
GAO Hui,GAO Jie,LUO Zhikai
(Department of Anesthesia, The Affiliated Hospital of Yan'an University)
Abstract:
【Abstract】Objective To investigate the effect of ropivacaine infusion anesthesia combined with intravenous dexamethasone on recovery of anesthesia in middle and old aged patients with esophageal cancer. Methods 120 patients underwent elective radical mastectomy in our hospital from January 2012 to December 2015 were randomly divided into group A (control group), group B (Rosivacaine group) and group C (ropivacaine group) and group D (ropivacaine combined with dizocine group). The changes of blood glucose, plasma cortisol (Cor), epinephrine (E) and norepinephrine (NE) were observed and compared. The restlessness during anesthesia, blood pressure and incidence of adverse reactions were observed. Results There were no significant differences in baseline, gender, age, body mass and ASA grading among the four groups(P> 0.05). T3 and DBP significantly increased in group A, B and C. HR in group A, B and C significantly increased (P<0.05). DBP of group D was significantly lower than that of the other three groups, and HR of group D was significantly slower than the other three groups (P<0.05). Blood glucose, Cor, E and NE were significantly increased in T1 ~ T4 groups (P<0.05). Compared with group A, the blood glucose, Cor, E and NE concentrations in group B, C and D were significantly lower than those in group A (P<0.05). Compared with B group and C group, the blood glucose, Cor, E and NE concentrations in T1 ~ T4 group were significantly low (P<0.05). The incidence of restlessness and hypertension in group B, C and D was significantly lower than that in group A (P<0.05). The incidence of restlessness and hypertension in group D was significantly lower than that in group B and C (P<0.05). There were no adverse reactions such as respiratory depression, dizziness, headache, sore throat and lethargy. Conclusion The combination of ropivacaine and docetaxel can reduce the occurrence of postoperative stress response in middle and old aged patients with esophageal carcinoma, which is beneficial to the stability of hemodynamics and worthy of clinical application.
Key words:  Ropivacaine  Dizzozin  Anesthesia  Restlessness  Cardiovascular response

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