李言民　焦妮妮

[摘要] 目的 整群在脑电双频指数（BIS）监测镇静深度指导下采用硬膜外复合静脉全麻的方式进行结直肠癌根治术的临床效果。方法 探讨选择该院2014年1月—2015年8月择期行结直肠癌根治术患者40例，采用随机数字法分为单纯静脉全麻组（GA组）和硬膜外复合静脉全麻组（GEA组），每组各20例，麻醉中维持BIS值在50～55。记录术前即入室安静后（T1）、切皮时（T2）、离断肿瘤时（T3）、术毕时（T4）、拔管即刻（T5）的血流动力学变化、静脉全麻药用量、平均拔管时间及有无术中知晓、术后躁动情况。 结果 GA组患者T3、T4、T5时点血压及心率较术前明显增高（P< 0.05），而GEA组患者各时点血压及心率较术前差异无统计学意义（P> 0.05），且GEA组患者T3、T4、T5时点血压及心率明显低于GA组（P< 0.05）；另GEA组患者术后平均拔管时间及全麻药物用量均明显低于GA组（P< 0.05）。两组患者均没有术中知晓发生。 结论 在BIS监测下，可以预防静脉全麻复合硬膜外麻醉的术中知晓，减轻结直肠癌根治术中的应激反应，减少异丙酚及芬太尼的用量，从而缩短苏醒时间，提高麻醉的安全性。

[关键词] 结直肠癌根治术；脑电双频指数（BIS）；硬膜外复合静脉全麻

[中图分类号] R4 [文献标识码] A [文章编号] 1674-0742（2015）12（c）-0012-03

The Clinical Research of Intravenous General Anesthesia Combined with Epidural Anesthesia Under BIS Monitoring Applied to the Radical Resection for Colorectal Cancer

LI Yan-min， JIAO Ni-ni

Department of Anesthesiology， Jiangsu Xuzhou City Hospital of TCM， Xuzhou， Jiangsu Province， 221006 China

[Abstract] Objective To explore the clinical effect of intravenous general anesthesia combined with epidural anesthesia with the bispectral index （BIS） monitoring of the depth of sedation in the radical resection for colorectal cancer. Methods 40 cases underwent elective radical resection for colorectal cancer in our hospital from January 2014 to August 2015 were randomly divided into general anesthesia group （GA group） and intravenous general anesthesia combined with epidural anesthesia （GEA group）， with 20 cases in each group. The BIS value was maintained at 50～55 during the anesthesia. The hemodynamics before the surgery， namely， after the sedation in the operating room（T1）， cutting the skin （T2）， dissection of the tumor（T3）， at the end of surgery （T4）， at the decannulation（T5）， dosage of drugs for general anesthesia， mean decannulation time， intraoperative awareness and postoperative agitation of the patients were recorded. Results The blood pressure and heart rate increased significantly in the GA group at T3， T4 and T5 compared with those at T1 （P<05）. The blood pressure and heart rate did not change significantly in the GEA group at T2， T3， T4 and T5 compared with those at T1（P>05）. The blood pressure and heart rate was much lower in the GEA group than that in the GA group at T3， T4 and T5， respectively （P<05）. The mean postoperative decannulation time was much earlier in the GEA group than that in the GA group （P<05）. The dosage of drugs for general anesthesia used in the GEA group was much less than that used in the GA group （P<05）. No intraoperative awareness occurred in both groups. Conclusion Intravenous general anesthesia combined with epidural anesthesia with the BIS monitoring can prevent the intraoperative awareness， relieve the stress response in the radical resection for colorectal cancer， reduce the dosage of propofol and fentanyl， shorten the time of emergence from the anesthesia and improve the safety of anesthesia.

[Key words] Radical resection for colorectal cancer； Bispectral index （BIS）； Intravenous general anesthesia combined with epidural anesthesia

在胸腹部手术中，硬膜外阻滞复合静脉全麻较单纯全麻具有伤害性刺激反应降低及术后并发症减少等优点，目前已被广泛应用[1-2]。由于术中硬膜外镇痛效果确切，全麻用药宜适量，麻醉过深时易导致患者术中循环抑制，太浅时又容易出现术中知晓[3]，因此，该研究采用脑电双频指数（BIS）监测术中镇静深度，进一步探讨硬膜外阻滞复合静脉全麻在结直肠癌根治术中的麻醉效果及安全性。整群选择该院2014年1月—2015年8月择期行结直肠癌根治术患者40例，现报道如下。

1 资料与方法

1.1 一般资料

整群选择该院2014年1月—2015年8月间择期行结直肠癌根治术患者40例，ASAⅠ～Ⅱ级，男28例，女12例，年龄40～70岁，体重43～78 kg，无明显心肺功能异常及出凝血功能障碍，无精神疾患，肝肾功能基本正常。……