Optimal concentration of ropivacaine in continuous epidural anesthesia combined with general anesthesia for radical resection of esophageal cancer
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目的 探讨食管癌根治术连续硬膜外麻醉复合全身麻醉中罗哌卡因的最适浓度.方法 回顾性病例系列研究.收集2020年2月至2022年2月山西省肿瘤医院100例接受食管癌根治术患者的临床资料,依据连续硬膜外麻醉复合全身麻醉中使用罗哌卡因的浓度将患者分为0.25％浓度组和0.50％浓度组,各50例.比较两组患者进入手术室时(T0)、全身麻醉诱导后5min(T1)、拔管时(T2)生命体征、镇痛效果、麻醉苏醒时间、麻醉满意度.结果 两组患者年龄、性别、体质量比较,差异均无统计学意义(均P＞0.05).两组T1的心率、平均动脉压(MAP)均低于T0、T2(均P＜0.05),但T0与T2的心率、MAP分别比较,差异均无统计学意义(均P＞0.05);T0、T1、T2两组间的心率、MAP分别比较差异均无统计学意义(均P＞0.05).0.25％浓度组静态视觉模拟评分法(VAS)评分低于0.50％浓度组[(1.24±0.28)分比(2.58±0.41)分,t=19.09,P＜0.05],动态 VAS 评分亦低于 0.50％浓度组[(2.86±0.47)分比(4.02±1.16)分,t=6.55,P＜0.05].0.25％浓度组自主呼吸恢复时间、拔管时间、完全清醒时间均短于0.50％浓度组,差异均有统计学意义(均P＜0.05).0.25％浓度组麻醉满意率高于0.50％浓度组[94％(47/50)比78％(39/50),x2=5.32,P＜0.05].结论 食管癌根治术连续硬膜外麻醉复合全身麻醉中罗哌卡因的最适浓度为0.25％.
Objective To investigate the optimal concentration of ropivacaine in continuous epidural anesthesia combined with general anesthesia for radical resection of esophageal cancer.Methods A retrospective case series study was conducted.A total of 100 patients with esophageal cancer undergoing radical surgery in Shanxi Province Cancer Hospital from February 2020 to February 2022 were collected.According to the concentration of ropivacaine in continuous epidural anesthesia combined with general anesthesia,all patients with esophageal cancer were divided into 0.25％concentration group and 0.50％concentration group,50 cases in each group.The vital signs,analgesic effects,time of recovery from anesthesia and satisfaction with anesthesia of the 2 groups at entering the operating room(T0),5 minutes after general anesthesia induction(T1),and time of extubation(T2)were compared.Results There were statistically significant differences in the age,gender,body mass of the both groups(all P＞0.05).The heart rate,mean arterial pressure(MAP)at T1 were lower than those at T0 and T2(all P＜0.05),but there were no significant differences in heart rate and MAP at T0 and T2(all P＞0.05);at T0,T1 and T2,there were no significant differences in HR and MAP between the both groups(all P＞0.05).The static visual analogue scale(VAS)score of patients in the 0.25％concentration group was lower than that in the 0.50％concentration group[(1.24±0.28)scores vs.(2.58±0.41)scores,t=19.09,P＜0.05],and the dynamic VAS score in the 0.25％concentration group was lower than that in the 0.50％concentration group[(2.86±0.47)scores vs.(4.02±1.16)scores,t=6.55,P＜0.05].The recovery time of spontaneous respiration,the extubation time and the time of complete consciousness in the 0.25％concentration group was shorter than those in the 0.50％concentration group(all P＜0.05).The anesthesia satisfaction in the 0.25％concentration group was higher than that in the 0.50％concentration group[94％(47/50)vs.78％(39/50),x2=5.32,P＜0.05].Conclusions The optimal concentration of ropivacaine in continuous epidural anesthesia combined with general anesthesia for radical resection of esophageal cancer is 0.25％.
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