| [Objective]To observe the application of 0.2% ropivacaine combined with sevoflurane as anesthetics on esophageal carcinoma patients clinical manifestations of postoperative complications and its mechanism.[Methods]First, the case selection and groupingSelect from 2013 to 2015 in our hospital for elective surgery were 89 cases of esophageal cancer, aged 65-90 years, ASA grade â… -â…¡ stage, in which 56 males and 33 females. We randomly divided its into observation group and control group, observation group of 44 cases and control group of 45 cases. Inclusion criteria:surgical indications, complete clinical data and no obvious allergies, experimental study of the voluntary. Second, anesthesia1.After the observation group is defined as A group, select thoracic T7-8 epidural puncture after puncture success, given the amount of 2% lidocaine hydrochloride test 3ml observed after 5 minutes, pumped 0.2% ropivacaine, induced by intravenous slow way, by giving midazolam 0.1mg/kg, sufentanil 0.5ug/kg, etomidate 0.03mg/kg, rocuronium 0.6 mg/kg induced completed the same double-lumen tube placement induction of anesthesia, sevoflurane combined with double-lumen tube after bronchoscopy accurate positioning. The control group is defined as group B, patients completed the same after induction of anesthesia, after intubation vein to control the input propofol injection 2.0ug/ml and hydrochloric acid remifentanil 3.0ng/ml. joint sevoflurane anesthesia was maintained.2. Routine monitoring ECG. oxygen saturation, end-tidal carbon dioxide, invasive arterial pressure, body temperature, central venous pressure. BIS monitoring, neuromuscular monitoring, blood gas analysis and urine.Third, the observed indicators1. By monitoring the mean arterial pressure (MAP) and heart rate (HR) change when induction of anesthesia, thoracotomy, extubation and after extubation time, labeled T1, T2, T3, T4 to determination circulation the changes. By muscle relaxant detector monitoring the patient muscle relaxant drug metabolism case, when TOF values greater than 70% to pay additional muscle relaxant drugs, compared to patients in the two groups were additional cases of muscle relaxants.2. Comparison of intraoperative oxygen supply situation two groups of patient, we monitoring the pulse oximetry, airway pressure changes, intraoperative refractory hypoxemia and carbon dioxide partial pressure.3.By monitoring anesthesia recovery time, early ambulation time, hospital stay and hospital cost situation to analyzing the relationship between patients fast recovery of anesthesia.4. By monitoring the incidence of postoperative delirium, analgesic satisfaction rate and plasma IL-6 change to analysis of the differences in the two anesthesia and postoperative analgesia of emergency.5. Comparison of postoperative complications and respiratory function after chest circumstances to analysis of differences between the two anesthetic.[result]1.Data surgery were observed in patients, refractory hypoxemia incidence observed groups of patients, airway pressure variations and intraoperative blood gas analysis of the situation of single-lung ventilation were significantly better than the control group, indicating that the two groups in patients undergoing oxygen respect for the difference was statistically significant (P<0.05).2. The two groups of patients intraoperative monitoring mean arterial blood pressure and heart rate in T1, T2, T3 and T4 time changes in hemodynamically stable patients is determined no significant change, the difference was not statistically significant (P> 0.05). Timely additional neuromuscular monitoring by TOF value when the patient is greater than 75% muscle relaxant drugs, there are significant differences between two groups in the additional amount of muscle relaxant drugs, statistically significant (P<0.05).3. The observation group and the control group of patients in anesthesia recovery time by recording, instruction eyes time and time to reflect removal of intubation anesthesia recovery time, early ambulation time, hospital stay and hospital cost case, data comparison control group was significantly higher in the observation group, with significant difference (P<0.05).4. The incidence of postoperative delirium data comparison groups of patients, analgesic satisfaction rate, with a statistically significant difference (P<0.05), was observed in patients after surgery to avoid intravenous analgesic drugs significantly improved analgesia and delirium rate decreased significantly. By IL-6 levels between the two groups before surgery were no statistically significant, after two groups of patients through surgery 1D,2D and 3D comparison control group was significantly higher than the observation group, epidural anesthesia in postoperative tissue surrounding stress and inflammatory responses have statistically significant (P<0.05).5. The observation group and the control group were observed in lung function in patients compare postoperative 3D, 1wk and 2wk respiratory rate, VC, FEV1, MVV respiratory rate were better than the control group of patients, VC, FEV1, MVV, the difference statistically significant (P<0.05).6. The observation group and the control group compared to the situation observed and compared postoperative complications and respiratory disorders empyema, anastomotic leakage, pulmonary infection, arrhythmia rate occurred in the observation group were less than the control group, the difference was statistically significant (P<0.05).[Conclusion]1. Thoracic epidural amide local anesthetic ropivacaine hydrochloride joint sevoflurane anesthesia patients maintain BIS values between 40-60, by contrast surgery patients at different times and heart rate changes in mean arterial blood draw patients in the observation group no aspect of hemodynamic stability compared with the control group, a significant difference, thoracic epidural hemodynamic under control after the application of low concentration ropivacaine. provide support for the continued study of muscle during surgery pine satisfactory avoid a lot of muscle relaxant drugs enter, and at the time of surgery and skeletal muscle recovery ventilator has obvious advantages.2. Thoracic epidural anesthesia combined with sevoflurane anesthesia during surgery hypoxemia, single-lung ventilation airway pressure and blood gas analysis analysis than the control group, can significantly improve patient OLV oxygen supply situation, to avoid insufficient oxygen supply resulting in postoperative respiratory failure.3. Significantly reduced postoperative complications, tracheotomy, ventilator support rate, delirium incidence rate has reduced to a large extent, improve postoperative analgesia, early ambulation, and avoid costly intravenous anesthesia drugs, economic cost decline of about one fifth.4. Through statistical analysis of patients in surgery, recovery time, autonomous recovery time after extubation tidal volume and postoperative lung function were significantly better than the control group, so the thoracic epidural anesthesia combined inhalation anesthesia facilitate patient recovery and rapid breathing technique after a quick rehabilitation has a good effect.5. Because of changes in anesthesia prompted to early rehabilitation of patients, and therefore decreased postoperative chest complications, stress change and peripheral inflammation in vivo by IL-6 expression was significantly better than the control group. |
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