Comparative Study Of Postoperative Effects Of Different Anesthetic Methods On Patients With Thoracotomy And Lobectomy

Objective:Comparing the effects of general anesthesia and epidural block combined with general anesthesia on postoperative recovery of thoracotomy patients,and to explore the advantages and disadvantages of different anesthetic methods during clinical thoracotomy.In order to provide reference for reasonable selection of appropriate anesthetic methods for patients undergoing thoracotomy.Materials and Methods:we selected patients that had underwent thoracotomy in QiLu Hospital from August 2016 to December 2017,and excluded patients which younger than 50 years or older than 65 years old,suffering from severe heart?lung?liver and kidney diseases,contraindications of epidural puncture and history of neuroendocrine system diseases.Finally,107 patients were enrolled into the study.According to different methods of anesthesia,we divided those patients into general anesthesia group and epidural anesthesia group,compared two groups of patients with general condition,dosage of anesthetic,perioperative hemodynamics,recovery period,anesthesia related complications,postoperative VAS score and postoperative satisfaction.Results:A total of 107 patients were included in the study,including 52 cases in general anesthesia group,55 cases in epidural block combined general anesthesia,the average age was 59.84 years old,and the proportion of men was higher than that of women.The proportion of overweight and obesity was higher than that of normal weight.There was no statistical difference between the general anesthesia group and the epidural block combined general anesthesia group about age,sex,BMI.(P>0.05).The dosage on anesthesia in two group patients,In general anesthesia group,midazolam induced dosage,Sufentanil induced dosage and Propofol induced dosage were higher than epidural block combined with general anesthesia group(P<0.05);In epidural block combined with general anesthesia epidural anesthesia group,rocuronium induced dosage,the amount of rocuronium maintenance,the amount of Suffen maintenance,the total dosageof Sulfinin and the total amount of rocuronium were higher than the general anesthesia group(P<0.05).The dosage of intravenous sedatives,analgesics and muscle relaxants in patients with general anesthesia were significantly higher than those in general anesthesia combined with epidural block(P<0.05).There was no significant difference between the two groups in the hemodynamic parameters at different time points(P>0.05).However,the systolic blood pressure in the general anesthesia group fluctuated significantly at different stages of the perioperative period.Epidural block combined with general anesthesia group was significantly less than the general anesthesia group about the time between the operation ended to full awake,and the difference was statistically significant(P<0.05).The incidence of restlessness in the general anesthesia group was significantly higher than that in the epidural block combined general anesthesia group(P<0.05).The incidence of anesthesia-related complications(nausea,vomiting,drowsiness,dizziness,cognitive impairment,etc.)in general anesthesia alone was significantly higher than that in epidural anesthesia combined with general anesthesia,the differences were statistically significant.Significance(P<0.05),there was no significant difference between the two groups of patients with postoperative pruritus incidence.The VAS score of 4h,second days after operation and third days after operation in the epidural block combined general anesthesia group were all lower than that in the simple general anesthesia group,and the difference was statistically significant(P<0.05).There was no significant difference in VAS score between the two groups after fourth days(P>0.05).In epidural block combined with general anesthesia group,postoperative bed time,postoperative exhaust time,postoperative catheter removal time and postoperative hospitalization time were all lower than those of general anesthesia group.The anesthesia satisfaction of patients in the combined epidural block and general anesthesia group was higher than that of the general anesthesia group(P<0.05).There was no significant difference in postoperative eating time between the two groups(P>0.05).Conclusion:For patients undergoing thoracotomy,clinical epidural block combined with general anesthesia has more advantages,compared with simple general anesthesia.Epidural anesthesia combined with general anesthesia can significantly reduce the postoperative to complete awake hours and the incidence of restlessness during resuscitation,reduce the incidence of postoperative anesthesia-related complications,and significantly reduce the postoperative recovery time and postoperative VAS scores.Anesthetic satisfaction of patients.