老年嗜铬细胞瘤手术患者不同麻醉方式与术后转归的关系

发布时间：2018-09-08 19:40

【摘要】：目的分析不同麻醉方式对老年嗜铬细胞瘤手术患者术后转归的影响。方法本研究回顾性收集2004年1月至2015年2月入住北京大学第一医院,年龄≥65岁,并行手术治疗的嗜铬细胞瘤患者。收集围术期相关指标包括:人口学资料,原发疾病,手术麻醉情况,术后化验检查,术后并发症及预后指标等。结果本研究纳入33例老年嗜铬细胞瘤患者。按照麻醉方式分为全麻组(G组,n=24)和全麻复合硬膜外组(GE组,n=11)。GE组术中应用瑞芬太尼(18.2%vs 79.2%,P=0.001)或舒芬太尼术中静脉维持镇痛(45.5%vs 79.2%,P=0.046)的比例明显低于G组。GE组术后机械通气时间(P=0.039)、术后住院时间(P=0.013)及住院总时间(P=0.015)均明显短于G组。Cox风险比例模型分析显示,全麻复合硬膜外麻醉为减少术后住院时间的独立保护因素(RR=0.245,95%CI 0.106~0.564,P=0.001),而术中升压药物联合应用为术后住院时间延长的独立危险因素(RR=4.184,95%CI 1.146~15.281,P=0.030)。结论老年嗜铬细胞瘤手术患者术中应用全麻复合硬膜外麻醉较单纯全身麻醉的静脉维持镇痛药物应用更少,机械通气时间更短,并明显缩短了术后住院时间及总住院时间。
[Abstract]:Objective to analyze the effect of different anesthetic methods on postoperative outcome of elderly patients with pheochromocytoma. Methods the patients with pheochromocytoma who were admitted to the first Hospital of Peking University from January 2004 to February 2015, aged more than 65 years, underwent surgical treatment. The related indexes of perioperative period include demographic data, primary diseases, anaesthesia, postoperative laboratory examination, postoperative complications and prognostic indicators. Results 33 elderly patients with pheochromocytoma were included in this study. General anesthesia group (G group) and general anesthesia combined epidural group (GE group 11). The proportion of intraoperative remifentanil (18.2%vs 79.2%) or sufentanil intraoperative analgesia (45.5%vs 79.2% P0.046) in GE group was significantly lower than that in group G and group GE during postoperative mechanical ventilation. Interval (P0. 039), postoperative hospitalization time (P0. 013) and total hospitalization time (P0. 015) were significantly shorter than those in group G. General anesthesia combined with epidural anesthesia was an independent protective factor to reduce postoperative hospital stay (RR=0.245,95%CI 0.106), while intraoperative blood pressure booster was an independent risk factor for prolonged postoperative hospital stay (RR=4.184,95%CI 1.146 卤15.281 P0.030). Conclusion in elderly patients with pheochromocytoma, general anesthesia combined with epidural anesthesia is used less and the time of mechanical ventilation is shorter than that of general anesthesia alone, and the postoperative hospital stay and total hospital stay are shortened obviously.
【作者单位】：北京大学第一医院重症医学科;北京大学肿瘤医院暨北京市肿瘤防治研究所麻醉科恶性肿瘤发病机制及转化研究教育部重点实验室;北京大学第一医院麻醉科;
【分类号】：R614

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