罗哌卡因浸润麻醉对食管癌根...应激反应和血流动力学的影响_赵蕊.pdf

癌症进展2022 年 12 月第 20 卷第 24 期ONCOLOGY PROGRESS,Dec 2022 V ol.20,No.24*论著*罗哌卡因浸润麻醉对食管癌根治术患者术后疼痛程度罗哌卡因浸润麻醉对食管癌根治术患者术后疼痛程度、应激反应应激反应和血流动力学的影响和血流动力学的影响赵蕊1，徐仙华2#，李海鹏3宝鸡市中心医院1麻醉科，3胸外科，陕西 宝鸡 721008延安大学咸阳医院2麻醉科，陕西 咸阳 7120000摘要摘要：目的目的探讨罗哌卡因浸润麻醉对食管癌根治术患者术后疼痛程度、应激反应和血流动力学的影响。方法方法依据麻醉方式的不同将80例食管癌患者分为常规组和罗哌卡因组，每组40例，常规组患者给予生理盐水切口浸润，罗哌卡因组患者给予罗哌卡因浸润麻醉。比较两组患者疼痛程度视觉模拟评分法（VAS）、血流动力学（收缩压、舒张压和心率）、应激反应（皮质醇、肾上腺素及去甲肾上腺素）及并发症发生情况。结果结果术后2、4、8、12、24 h，罗哌卡因组VAS评分均明显低于常规组（P0.01）。术毕、拔管即刻、拔管后10 min、拔管后30 min，两组患者的收缩压均高于本组麻醉诱导前，差异均有统计学意义（P0.05）；拔管后10 min，两组患者舒张压、心率均高于本组麻醉诱导前，但罗哌卡因组患者舒张压、心率均低于常规组，差异均有统计学意义（P0.05）。术毕、拔管即刻、拔管后10 min、拔管后30 min，两组患者皮质醇、肾上腺素及去甲肾上腺素水平均高于本组麻醉诱导前，但罗哌卡因组患者皮质醇、肾上腺素及去甲肾上腺素水平均低于常规组，差异均有统计学意义（P0.05）。罗哌卡因组患者的并发症总发生率为5.00%（2/40），与常规组患者的17.50%（7/40）比较，差异无统计学意义（P0.05）。结论结论罗哌卡因浸润麻醉可有效减轻食管癌患者的疼痛程度，减轻应激反应，改善血流动力学。关键词关键词：食管癌根治术；罗哌卡因；浸润性麻醉；疼痛；血流动力学中图分类号中图分类号：R R735735.1 1文献标志码文献标志码：AdoiAdoi：10.11877/j.issn.1672-1535.2022.20.24.15Effect of ropivacaine infiltration anesthesia on postoperative pain degree,stressEffect of ropivacaine infiltration anesthesia on postoperative pain degree,stressresponse and hemodynamics in patients with esophageal cancer undergoingresponse and hemodynamics in patients with esophageal cancer undergoingradical resectionradical resectionZHAO Rui1,XU Xianhua2#,LI Haipeng31Department of Anesthesiology,3Department of Thoracic Surgery,Baoji Central Hospital,Baoji 721008,Shaanxi,China2Department of Anesthesiology,Xianyang Hospital of Yan an University,Xianyang 712000,Shaanxi,ChinaAbstract:ObjectiveAbstract:ObjectiveTo investigate the effect of ropivacaine infiltration anesthesia on the degree of pain,stress re-sponse and hemodynamics in patients with esophageal cancer undergoing radical resection.MethodMethodA total of 80 pa-tients with esophageal cancer were divided into routine group and ropivacaine group according to different anesthesiamethods with 40 cases in each group.Patients in the routine group were given normal saline incision infiltration,and pa-tients in the ropivacaine group were given ropivacaine infiltration anesthesia.The pain visual analogue scale(VAS),he-modynamics(systolic blood pressure,diastolic blood pressure,and heart rate),stress response(cortisol,epinephrine,andnorepinephrine),and complications were compared between the two groups.ResultResultThe VAS scores of the ropivacainegroup were lower than those of the routine group at 2,4,8,12,24 h after the operation(P0.01).At the end of operation,immediately after extubation,10 minutes after extubation,and 30 minutes after extubation,the systolic blood pressure ofpatients in the two groups was higher than that before anesthesia induction,and the differences were statistically signifi-cant(P0.05).Ten minutes after extubation,the diastolic blood pressure and heart rate of the patients in the two groupswere higher than those before anesthesia induction,but the diastolic blood pressure and heart rate of the patients in theropivacaine group were lower than those in the routine group,with the differences were statistically significant(P0.05).At the end of operation,immediately after extubation,10 minutes after extubation,and 30 minutes after extubation,thelevels of cortisol,epinephrine,and norepinephrine in the two groups were higher than those before anesthesia induction,but the levels of cortisol,epinephrine,and norepinephrine in the ropivacaine group were lower than those in the conven-tional group,with differences were statistically significant(P0.05).ConclusionConclusionRopivacaine infiltration anesthesia can effectively reduce the degree of pain in patientswith esophageal cancer,reduce stress response,and improve hemodynamics.#通信作者（corresponding author），邮箱：2537癌症进展2022年12月第20卷第24期Key words:Key words:radical resection of esophageal cancer;ropivacaine;infiltration anesthesia;pain;hemodynamicsOncol Prog,2022,20(24)食管癌是常见的恶性肿瘤，其典型症状为进行性吞咽困难，先是干的食物难以吞咽，继而是半流质食物，最后水和唾液也难以下咽1。全球每年食管癌病死例数约30万例，且由于食管癌的早期症状不明显，患者易出现严重的进食梗阻，发病率和病死率均较高2。因此，早期诊断和早期治疗对提高食管癌患者的生存率有重要意义3。食管癌根治术是临床治疗食管癌的主要方式，但受手术创伤大、多种管道刺激等因素的影响，容易使患者出现苏醒期躁动和血流动力学指标变化4。传统的手术麻醉方式主要是采用芬太尼或舒芬太尼等镇痛药物抑制苏醒期躁动，但会诱发呼吸抑制和苏醒延迟等并发症。罗哌卡因具有镇痛和麻醉的双重功效，心脏毒性和神经毒性的发生率较低，临床常用于外科手术的硬膜外麻醉及分娩镇痛等5。本研究探讨罗哌卡因浸润麻醉对食管癌根治术患者术后疼痛等的影响，现报道如下。1 1资料与方法资料与方法1 1.1 1 一般资料一般资料选取2020年1月至2021年5月宝鸡市中心医院收治的食管癌患者。纳入标准：符合 食管癌诊疗规范（2018年版）6中关于食管癌的诊断标准；美国麻醉医师协会分级为级；近期未使用过激素、拮抗剂等药物；对局部麻醉药无过敏；临床资料完整。排除标准：药物过敏史及依赖史；肝肾严重功能障碍；心动过缓；严重脊柱或胸廓畸形；糖皮质激素使用禁忌证；穿刺部位皮肤感染或破损。根据纳入、排除标准，共纳入80例食管癌患者，依据麻醉方式的不同分为常规组和罗哌卡因组，每组40例，常规组患者给予生理盐水切口浸润，罗哌卡因组患者给予罗哌卡因浸润麻醉。常规组中，男25例，女15例；年龄4575岁，平均（60.223.12）岁；体重指数 1626 kg/m2，平均（22.352.25）kg/m2；肿瘤部位：上段 20 例，中段 12例，下段 8 例。罗哌卡因组中，男 22 例，女 18 例；年龄4777岁，平均（60.563.10）岁；体重指数1725 kg/m2，平均（22.252.20）kg/m2；肿瘤部位：上段18例，中段12例，下段10例。两组患者性别、年龄、体重指数和肿瘤部位比较，差异均无统计学意义（P0.05），具有可比性。本研究经医院伦理委员会批准通过，所有患者均知情同意并签署知情同意书。1 1.2 2 麻醉方法麻醉方法患者入手术室后常规监测心电图、血氧饱和度及血流动力学指标，局部麻醉下进行桡动脉穿刺置管。麻醉诱导：丙泊酚2 mg/kg、舒芬太尼0.5 g/kg、咪达唑仑0.05 mg/kg、苯磺顺阿曲库铵0.15 mg/kg。麻醉维持：静脉泵注丙泊酚4 mg/（kg h）和瑞芬太尼 0.1 g/（kg min），缝皮时停止泵注丙泊酚和瑞芬太尼。常规组患者给予生理盐水 20 ml 浸润切口，罗哌卡因组患者于切皮前10 min给予0.