Objective To evaluate the influence of combined general and epidural anesthesia on the prognosis of patients undergoing cancer surgery. Methods Such database as PubMed, OVID, EBSCO, The Cochrane Library and CNKI were searched, and other relevant journals and references of the included literature were also hand searched from 1986 to 2011. Two evaluators independently screened the studies in accordance with the inclusion and exclusion criteria, extracted the data and assessed the methodology quality. RevMan 5.0 software was used for meta-analyses. Results Seven studies involving 2 513 patients were included. The results of meta-analyses showed that compared with the single general anesthesia, the combined general and epidural anesthesia had no significant differences in postoperative recurrence and metastasis rate (OR=0.71, 95%CI 0.44 to 1.17, P=0.18). Based on the following four factors i.e. category of cancer, time of follow-up, having preoperative metastais or not, and patients’ age, the sensitivity analysis showed significant differences in the postoperative recurrence and metastasis rate between the two anesthesia methods were found in the group of patients at or above 64 years old and the group with follow-up equal to or less than two years (OR=1.46, 95%CI 1.00 to 2.14, P=0.05; OR=1.55, 95%CI 1.06 to 2.26, P=0.02; respectively). Nevertheless, there was no significant difference in the groups of patients with colorectal cancer or without preoperative metastasis (OR=1.00, 95%CI 0.62-1.61, P=0.99; OR=1.26, 95%CI 0.86 to 1.86, P=0.23; respectively). Conclusion Compared with single general anesthesia, the combined general and epidural anesthesia cannot reduce the recurrence and metastasis rate for cancer patients, and has no marked improvement in prognosis of patients with colorectal cancer or without preoperative metastasis, but it obviously decreases the probability of forward recurrence and metastasis for the patients at or above 64 years old and the patients with follow-up equal to or less than two years.
Objective To investigate the most suitable anaesthesia method for the tension-free herniorrhaphy.Methods A total of 422 unilateral inguinal hernia cases from 2002 to 2005 were collected and randomly divided into the local anaesthesia group and epidural anaesthesia group. Observation indices and some relative data, such as operative duration, date of ambulation, date of foodintake, length of hospital stay, operation-correlated complications, anaesthesia complications, usage rate of ancillary drug, satisfactory rate for anesthesia, cost of hospitalization, were included and recorded in the questionnaire, and all the patients who took the tension-free herniorrhaphy were asked to answer it as the follow-up research. Results It was found that the occurrence of postoperative anaesthetic complications, the cost of hospitalization, length of stay of local anaesthesia group were significantly less than those of epidural anaesthesia group, and the date of moving and the date of foodintake were also significantly earlier than those of the other group (P＜0.05). However, there was no significant difference of operative duration, postoperative recovery situation and the satisfactory rate between two groups (P＞0.05).Conclusion The local anaesthesia is suitable for most of the tension-free herniorrhaphy, and it may be used as the conventional anaesthetic method.
Objective To observe the effects of epidural anaesthesia (EA) and general anaesthesia (GA) on the changes of plasma epinephrine (E) and norepinephrine (NE) during laparoscopic cholecystectomy (LC). Methods Thirty patients undergoing elective LC were randomly divided into GA group (n＝15) and EA group (n＝15). The concentrations of plasma NE and E were measured at the following phases: before anaesthesia, before introducing pneumoperitoneum, during pneumoperitoneum, and at the end of operation. Results In EA group, the concentrations of NE weren′t significantly different at each phase, the concentrations of E significantly increased before and during pneumoperitoneum (Ｐ＜0.05) and returned to the baseline at the end of operation (Ｐ＞0.05). In GA group, the concentrations of NE and E didn′t change significantly before pneumoperitoneum, but increased during pneumoperitoneum (Ｐ＜0.05) and E didn′t return to the baseline at the end of operation (Ｐ＜0.05). The E concentrations of EA group was higher than that of GA group before pneumoperitoneum, but the NE concentration of EA group was lower than that of GA group during pneumoperitoneum (Ｐ＜0.05). Conclusion Both groups has significant stress reaction, but the stress reaction of EA group is weaker than that of GA group during LC.
目的 評價硬膜外麻醉合用丙泊酚用于腹腔鏡膽囊切除術的可行性。方法 擇期行腹腔鏡膽囊切除術患者850例，經T 9～10椎間隙行硬脊膜外腔穿刺置管，給予常規劑量的2%利多卡因或0.75%布比卡因，氣腹前靜脈注射丙泊酚1～2 mg/kg,直至患者意識消失，繼以10 mg/(kg·h)維持麻醉深度。結果 全組850例患者術中麻醉效果好，腹肌松弛，意識消失后避免了氣腹引起的牽扯反射，停止使用丙泊酚10 min左右時間，大部分患者即恢復呼喚反應。 結論 硬膜外麻醉合用丙泊酚用于腹腔鏡膽囊切除術是一種效果很好的臨床麻醉方法。
Objective To compare the effects of epidural anesthesia with intubated anesthesia in the postoperative recovery of patients with thoracoscopic resection of lung bullae. Methods Sixty patients (53 males, 7 females, aged 16-65 years) undergoing thoracoscopic resection of unilateral pulmonary bullae in our hospital from December 2014 to December 2015 were randomly divided into two groups: a group A (epidural anesthesia group) received thoracic epidural block combined with intraoperative interthoracic vagus nerve block; a group B (general anesthesia group) received general anesthesia with double lumen endobronchial intubation and pulmonary sequestration. Postoperative anesthesia-related complications and postoperative recovery were recorded. Results Both of the two anesthesia methods could meet the requirements of operation. The patients with the vocal cord injury and sore throat in the group B were more than those in the group A. The difference was statistically significant in the incidence of sore throat (P<0.01) . Arterial partial pressure of oxygen (PaO2) in the group A was significantly higher than that of group B before lung recruitment (P<0.01). Compared with the group B, the group A had less visual analogue scale (VAS) score (P<0.05), earlier activity and feeding, less postoperative ICU and hospital stay (P<0.01). Conclusion Epidural anesthesia combined with intraoperative interthoracic vagus nerve block can meet thoracoscopic bullectomy surgery requirements with few complications and fast postoperative recovery.
【摘要】 目的 評價撫觸對硬膜外麻醉穿刺疼痛的影響及效果。 方法 2009年1-12月，將485例行硬膜外麻醉穿刺患者隨機分為撫觸組（術中行撫觸干預）和對照組（常規護理），觀察兩組患者的穿刺程度、穿刺時間。 結果 撫觸組患者疼痛程度、穿刺時間較對照組有明顯改善，且差異有統計學意義（Plt;0.01）。 結論 撫觸可降低應激引起的硬膜外麻醉穿刺患者的疼痛程度，保持穿刺體位從而縮短穿刺時間，有利于麻醉操作順利進行。【Abstract】 Objective To evaluate the effect of touching on alleviating the pain in patients undergoing epidural anesthesia puncture. Methods A total of 485 patients who underwent epidural puncture from January to December 2009 were randomly divided into two groups: 259 in touching group and 226 in control group. In the touching group, the patients were touched and consoled while undergoing epidural puncture. The pain extent and time of puncture were observed and recorded. Results The level of pain and time of puncture were obviously alleviated and shortened in the touching group and the difference between the two groups was statistically significant. Conclusion Touching could reduce the stress and pain caused by epidural puncture, which may lead to maintain the puncture position and thereby shorten the puncture time. It helps to finish the narcotic operation favorably.
ObjectiveTo evaluate the arthroscopic treatment effectiveness of popliteal cyst excision in combination with debridement of the knee under local anesthesia by comparing with continuous epidural anesthesia. MethodsBetween June 2002 and January 2013,145 patients with popliteal cyst underwent arthroscopic popliteal cyst excision in combination with debridement of the knee under local anesthesia (local anesthesia group).In addition,51 patients with popliteal cyst were treated with the same surgery under continuous epidural anesthesia between February 2000 and August 2005 served as control group.No significant difference was found in gender,age,side,disease duration,or cyst size between 2 groups (P>0.05).Then,anesthesia time,analgesia effect,anesthesia satisfaction,operation time,bleeding volume,and anesthesia complication were compared between 2 groups.The guidelines of Rauschning and Lindgren were used to assess the effectiveness,and recurrence rate was recorded. ResultsAll incisions healed primarily,no neurological or vascular injury was found.The patients were followed up 1 year and 1 month to 8 years (mean,3.7 years) in local anesthesia group,and 8 years to 13 years and 7 months (mean,10.8 years) in control group.Local anesthesia group had shorter anesthesia time,higher visual analogue scale (VAS) score,shorter operation time,and lower bleeding volume (P<0.05) than control group.Anesthesia satisfaction was reduced in local anesthesia group,but there was no significant difference (χ2=0.071,P=1.000).The anesthesia complication incidence of control group (15.7%,8/51) was significantly higher than that of local anesthesia group (0) (P=0.000).Recurrence was found in 12 patients of local anesthesia group (curative ratio 91.7%) and in 5 patients of control group (curative ratio 90.2%),showing no significant difference (χ2=0.111,P=0.774).According to the guidelines of Rauschning and Lindgren,there were 131 cases of grade 0,13 cases of grade I,and 1 case of grade Ⅱ in local anesthesia group,and 37 cases of grade 0,12 cases of grade I,and 2 cases of grade Ⅱ in control group; significant differences in grading were shown between at pre- and post-operation in 2 groups (Z=-10.683,P=0.000; Z=-6.385,P=0.000),and between 2 groups at post-operation (Z=-3.145,P=0.002). ConclusionCompared with under continuous epidural anesthesia,arthroscopic treatment of popliteal cyst excision under local anesthesia can obtain better results.Under local anesthesia,the condition of nerve and vessel can be timely and dynamically observed.Arthroscopic treatment of popliteal cyst excision in combination with debridement of the knee has the advantages of less trauma,lower recurrence rate,and satisfactory results.
至2002年4月,分娩期會陰保護的證據如下: ①合成的可吸收材料在分娩期外陰1、2度撕傷修補和外陰切開中的應用(可以減少疼痛時間):1個系統評價發現,使用合成的可吸收縫合線相對于普通腸線明顯減少了分娩后10天內鎮痛藥的使用劑量.對于分娩期的疼痛和分娩3個月后的性交痛,合成的可吸收材料與普通腸線無顯著差別.系統評價中的一個大規模RCT發現,合成的可吸收材料在分娩后12個月顯著降低性交痛. ②皮下連續縫合材料在外陰1、2度撕傷修補和外陰切開中的應用(減少疼痛時間):1個系統評價發現,皮下連續縫合相對間斷縫合明顯減輕了分娩后10天以內的疼痛.③分娩期對病人持續的支持(減少助產器械的使用):1個系統評價發現,分娩期對產婦持續的支持(注釋:分娩過程中有護士、助產士等專業人士陪伴,并提供咨詢)明顯減少了助產器械的使用及會陰切開,但不能防止分娩期損傷的發生.④各種方法和材料在3、4度撕傷修補中的應用: 我們沒有找到評論外陰3、4度撕傷修補最好的材料和方法的RCT.⑤硬膜外麻醉(增加了助產的機率,從而增加了會陰損傷的機率):1個系統評價沒有找到直接的證據來比較硬膜外麻醉和其他麻醉對會陰損傷的影響.但是,一些RCT發現,僅在第一產程使用硬膜外麻醉和在第一產程及二、三產程都使用硬膜外麻醉相比,后者的器械助產及會陰損傷風險顯著升高.⑥不協助孕婦分娩和協助分娩的比較( 增加了孕婦疼痛,無證據顯示會陰損傷風險及會陰切開機率減少):1個RCT發現,不協助孕婦分娩(不接觸胎兒頭部或者保護產婦會陰)與協助產婦分娩(分娩期在胎頭上施壓及保護產婦會陰)相比,顯著增加了產后10天的疼痛但卻減少了會陰切開的機率.但無證據顯示前者增加了會陰損傷風險或3、4度外陰撕傷風險.⑦會陰正中切開(相比會陰側切增加了3、4度會陰撕傷機率):無證據顯示會陰正中切開能比會陰側切減少會陰疼痛或者傷口裂開的機率.一項來自半隨機試驗的有限證據表明,會陰正中切開可能增加3、4度會陰撕傷的機率.⑧會陰2度撕傷及會陰切開后不縫合會陰肌肉: 1個小樣本RCT發現,在皮膚燒灼感和痛覺上,縫合與不縫合肌肉在產后2～3天,愈合后2～3天或產后8周沒有差別.⑨會陰1、2度撕傷和切開后不縫合會陰皮膚(減少了性交痛): 1個大樣本RCT發現,不縫合皮膚與常規縫合相比,產后10天疼痛沒有顯著差異,但卻顯著減少了分娩3個月后的性交痛.⑩第二產程胎頭被動下降: 1個RCT比較了胎頭被動下降和主動推動胎頭快速下降,結果發現二者對會陰損傷沒有差別.(11)限制性的會陰切開 (減少了后壁的損傷): 1個系統評價發現,對有胎兒或母親指征的產婦限制性使用會陰切開能顯著減少會陰后壁的撕傷,但卻增加了陰道前壁及陰唇的損傷風險.(12)持續性的屏氣向下用力:1篇來自2個質量不高的臨床對照試驗的系統評價發現,第二產程向下用力時,屏氣與不屏氣對會陰撕傷的發生率及程度沒有影響.1篇RCT比較胎頭被動下降與屏氣用力推動胎頭下降,二者對會陰撕傷率也沒有影響.(13)分娩期體位:1個系統評價比較了直立位、仰臥位和側臥位,結果發現分娩期直立位顯著降低了會陰切開機率,卻明顯增加了會陰2度撕傷的風險.(14)胎頭吸引(相比產鉗減少了會陰損傷,但增加了新生兒腦出血風險):1個系統評價發現,胎頭吸引器與產鉗相比,顯著降低了會陰損傷機率,但增加了新生兒腦出血和視網膜出血的風險.
Objective To explore anesthetic quality of epidural anesthesia with general anesthesia applied for surgery of rectal cancer. Methods One hundred and seventy-eight patients who were diagnosed as rectal cancer and received operation in the Central Hospital of Bazhong City from June 2010 to June 2012 were included retrospectively. These patients were divided into two groups according to the type of anesthesia， and the patients who received general anesthesia only were defined as group A， the patients who received epidural anesthesia with general anesthesia were defined as group B. The anesthetic quality and anesthetic adverse reaction were observed in two groups. Results The differences of baseline characteristics in two groups were not significant （P＞0.05）. The difference of anesthetic quality in two groups was not significant （P＞0.05）. In terms of anesthetic adverse reaction， the incidence rate of hypertension， hypotension，tachycardia， or postoperative nausea and vomiting of the group B was significantly lower than those of the group A （P＜0.05）. The incidence rate of bradycardia， premature ventricular contractions， or time of gastrointestinal function recovery had no significant differences （P＞0.05）. There was no nerve dysfunction of lower limb in two groups. Conclusion Epidural anesthesia with general anesthesia applied for surgery of rectal cancer as compared with general anesthesia only not only has the same anesthetic quality， but also has obvious advantages in decreasing anesthetic adverse reaction.