硬膜外联合全身麻醉对老年虚弱患者胃癌根治术后谵妄发生率及术后恢复情况的影响

Effects of Epidural Anesthesia on Delirium Incidence and Recovery in Elderly Frail Patients Undergoing Gastrectomy

摘要: 目的：研究硬膜外麻醉联合全身麻醉对老年虚弱行胃癌根治术后谵妄发生率及术后恢复情况的影响。方法：选择2021年6月到2022年6月在青岛大学附属医院行胃癌根治手术的110例老年患者，患者术前诊断为虚弱状态。按麻醉方式将患者分为两组，观察组患者接受硬膜外麻醉联合全身麻醉，对照组患者接受全身麻醉。比较两组患者的麻醉药物用量，术中平均动脉压、尿量、失血量、心率；术后第1天(T₁)，第2天(T₂)，第3天(T₃)，第4天(T₄)，第5天(T₅)谵妄发生率；两组患者的术后NRS疼痛评分，术后第1天(T₁)，第2天(T₂)，第3天(T₃)的炎症指标，术后胃肠道恢复情况等。结果：观察组患者消耗了更少的麻醉药物，麻醉过程中的心率更快，平均动脉压更低(P < 0.05)；观察组患者术后第1天和第2天的谵妄发生率为12.7%和14.5%，显著低于对照组患者的30.9%和34.5%，比较差异有统计学意义(P < 0.05)；观察组患者术后NRS疼痛评分好于对照组(P < 0.05)；观察组术后IL-6水平高于对照组(P < 0.05)；观察组患者术后首次经口进食时间早于对照组(P < 0.05)。结论：硬膜外麻醉联合全身麻醉减少了麻醉药物的用量，减少了术后谵妄的发生，缓解了术后炎症反应，加快胃肠道恢复。

Abstract: Objective: To study the effect of epidural anesthesia combined with general anesthesia on the incidence of delirium and postoperative recovery after radical gastrectomy for frail elderly patients. Methods: A total of 110 elderly patients who underwent radical gastrectomy for gastric cancer at the Affiliated Hospital of Qingdao University from June 2021 to June 2022 were selected and preoperatively diagnosed with debilitated state. The patients were divided into two groups according to the anesthesia method. The patients in the observation group received epidural anesthesia combined with general anesthesia, and the patients in the control group received general anesthesia. The dosage of anesthetic drugs, intraoperative mean arterial pressure, urine volume, blood loss and heart rate were compared between the two groups; the incidence of delirium on postoperative day 1 (T₁), day 2 (T₂), day 3 (T₃), day 4 (T₄) and day 5 (T₅); the postoperative NRS pain score, inflammatory indicators on postoperative day 1 (T₁), day 2 (T₂), and day 3 (T₃) and postoperative gastrointestinal recovery were compared between the two groups. Results: The patients in observation group consumed less anesthetic drugs, had faster heart rate and lower mean arterial pressure during anesthesia (P < 0.05); the incidence rate of delirium on postoperative d1 and d2 in observation group was 12.7% and 14.5%, significantly lower than 30.9% and 34.5% in control group, and the difference had statistical significance (P < 0.05); the postoperative NRS pain score in observation group was better than that in control group (P < 0.05); the postoperative IL-6 level in observation group was higher than that in control group (P < 0.05); the first oral feeding time in observation group was earlier than that in control group (P < 0.05). Conclusion: Epidural anesthesia combined with general anesthesia reduces the dosage of anesthetic drugs, reduces the occurrence of postoperative delirium, relieves postoperative inflammatory reactions, and accelerates gastrointestinal recovery.