不同麻醉方式对老年直肠癌患者应激反应及血流动力学的影响

Effect of Different Anesthetic Techniques on Stress Response and Hemodynamics in Elderly Patients with Colorectal Cancer

目的探讨不同麻醉方式(全身麻醉和全身麻醉复合硬膜外麻醉)对老年直肠癌患者应激反应及血流动力学的影响。方法选取120例行腹腔镜直肠癌根治术患者,随机分为对照组和观察组,各60例。对照组采用气管插管全麻,观察组采用气管插管全麻复合硬膜外麻醉,比较2组患者麻醉前(T0)、气管插管后即刻(T1)、气腹后30 min(T2)、拔管后5 min(T3)、拔管后2 h(T4)的应激反应及血流动力学的变化。结果与T0比较,2组患者在T1、T2、T3时间点时BS、NE、AE和Cor水平均明显升高,差异具有统计学意义(P<0.05)。2组患者在T4时间点时NE、AE和Cor水平均明显高于T0时间点,差异具有统计学意义(P<0.05)。观察组在T1、T2、T3和T4时间点时NE、AE和Cor水平均显著低于对照组,差异具有统计学意义(P<0.05)。观察组在T1、T2和T3时间点时BS水平均显著低于对照组,差异具有统计学意义(P<0.05)。观察组患者在T1、T2、T3和T4时间点时MAP和HR与对照组比较,差异均具有统计学意义(P<0.05)。观察组患者在T1、T2和T3时间点时SBP和DBP与对照组比较,差异均具有统计学意义(P<0.05)。结论全麻复合硬膜外麻醉能够减轻机体应激反应,且血流动力学更为稳定,值得在老年直肠癌患者手术中推广。

Objective To discuss the effect of different ways of anesthesia （general anesthesia and general anesthesia combined with epidural anesthesia） on stress response and hemodynamics in elderly patients with colorectal cancer. Methods 120 elderly patients with colorectal cancer were randomly divided into the control group and the observation group, each with 60 cases. The control group were given general anesthesia, the observation group were given general anesthesia combined with epi- dural anesthesia. Stress response and hemodynamic before anesthesia（ T0）, immediately after intubation（ T1 ）, after pneumoperito- neum 30 min （T2）, after extubation 5 min（ T3 ）, after extubation 2 h （T4） of the 2 groups were compared. Results Compared with TO, BS, NE, AE and Cor level of the 2 groups patients at T1, T2, T3 were significantly higher, the difference was statistically significant （ P 〈 0.05 ）. NE, AE and Cor of the 2 groups at T4 were significantly higher than TO, the difference was statistically signifieant（P 〈0.05 ）. NE, AE and Cor at T1, T2, T3 and T4 in the observation group were significantly lower than the control group, the difference was statistically significant （ P 〈 0.05 ）. BS in observation group were significantly lower than the control group at T1, T2 and T3 time points, the difference was statistically Significant （ P 〈 0.05 ）. Compared to the observation group and the control group, MAP and HR at TI, T2, T3 and T4, the differences were statistically significant （P 〈 0.05 ）. Compared with the SBP and DBP at T1 ,T2 and T3 ,the differences between the 2 group were statistically significant（ P 〈 0.05 ）. Conclusion General anesthesia combined with epidural anesthesia can reduce the stress response with more stable hemodynamie, it is worthy of promotion in elderly patients with colorectal cancer.