硬膜外阻滞复合全身麻醉对腹腔镜结直肠癌根治术患者氧合功能及应激反应的影响

Effect of Epidural Block Combined with General Anesthesia on Oxygenation Function and Stress Response in Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer

目的探究硬膜外阻滞复合全身麻醉对腹腔镜结直肠癌根治术患者氧合功能及应激反应的影响。方法选取2017年8月至2019年9月收治的92例行腹腔镜结直肠癌根治术治疗的结直肠癌患者作为研究对象,按照类层抽样法分为两组,各46例,其中对照组采用单纯全身麻醉,观察组通过硬膜外阻滞复合全身麻醉。评估入手术室后10 min(T0)、气腹15 min(T1)、气腹30 min(T2)及拔管时(T3)的肺内血分流率(QS/QT)、乳酸(ABL)、白细胞计数(WBC)、皮质醇(COR)、C-反应蛋白(CRP)、血糖(GLU),以及评估T0、T4、T5、T6的CD3^(+)、CD4^(+)、CD8^(+)以及CD4^(+)/CD8^(+)。结果重复测量结果显示,两组患者QS/QT、ABL、WBC、COR主体内效应、主体间效应比较差异均有统计学意义(P均<0.05)。两组CRP的时点、交互比较差异均有统计学意义(P均<0.05),而两组的CRP的组间比较差异无统计学意义(P>0.05);两组GLU的时点、组间比较差异均有统计学意义(P均<0.05),两组GLU的交互比较差异无统计学意义(P>0.05)。两组CD3^(+)、CD4^(+)的时点比较差异均有统计学意义(P均<0.05),而两组CD3^(+)、CD4^(+)的组间、交互比较差异无统计学意义(P>0.05);两组CD8^(+)、CD4^(+)/CD8^(+)主体内效应、主体间效应比较差异无统计学意义(P均>0.05)。简单效应LSD-t成对比较显示,T0时点,两组QS/QT、ABL、WBC、COR、CRP、GLU、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)比较差异均无统计学意义(P均>0.05);T1、T2、T3时点,观察组的QS/QT、ABL低于对照组(P均<0.05)。T1时点,两组WBC、COR、CRP比较差异无统计学意义(P>0.05),且观察组的GLU低于对照组(P<0.05);T2、T3时点,观察组的WBC、COR、CRP、GLU均低于对照组(P均<0.05)。T4时点,两组CD3^(+)、CD4^(+)比较差异无统计学意义(P均>0.05),且观察组的CD4^(+)、CD4^(+)/CD8^(+)高于对照组(P均<0.05);T5时点,两组的CD3^(+)、CD8^(+)、CD4^(+)/CD8^(+)比较差异无统计学意义(P均>0.05),且观察组的CD4^(+)高于对照组(P均<0.05);T6时点,观察组的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于对照组(P均<0.05);而两组的CD8^(+)比较差异无统计学意义(P>0.05)。结论硬膜外阻滞复合全身麻醉对腹腔镜结直肠癌根治术的效果更好,能减轻应激反应,改善氧合功能。

Objective To explore the effect of epidural block combined with general anesthesia on oxygenation function and stress response in patients undergoing laparoscopic radical resection of colorectal cancer.Methods A total of 92 patients with colorectal cancer who underwent laparoscopic radical resection of colorectal cancer who were admitted from August 2017 to September 2019 were selected as the research objects.They were divided into two groups according to the stratified sampling method,each with 46 cases,of which the control group performed simple general anesthesia was used during the operation,while the observation group was combined with general anesthesia by epidural block.The blood shunt rate(QS/QT),lactate(ABL),white blood cell count(WBC)of the lung 10 min(T0),15 min of pneumoperitoneum(T1),30 min of pneumoperitoneum(T2)and extubation(T3)after the operating room,cortisol(COR),C-reactive protein(CRP),blood glucose(GLU),and CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)were assessed to evaluate T0,T4,T5,T6.Results The repeated measurements showed that the differences in QS/QT,ABL,WBC,COR and inter-agent effects between the two groups were statistically significant(P all<0.05).The difference of CRP time point and interaction between the two groups was statistically significant(P all<0.05),while the difference of CRP between the two groups was not statistically significant(P>0.05).There were statistically significant differences in the time points and intergroup comparisons of GLU between the two groups(P all<0.05),while no statistically significant differences in the interaction of GLU between the two groups(P>0.05).There were significant differences in the time points of CD3^(+)andCD4^(+)between the two groups(P all<0.05),while there was no difference in the intergroup and interaction between the two groups(P>0.05).There was no difference between the two groups in CD8^(+),CD4^(+)/CD8^(+)intra-agent effect and inter-agent effect(P all>0.05).Simple effect ISD-t paired comparison showed that at T0,there was no statistically significant difference in QS/QT,ABL,WBC,COR,CRP,GLU,CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)between the two groups(P all>0.05).At time points T1,T2 and T3,QS/QT and ABL in the observation group were lower than those in the control group(P all<0.05).At T1,there was no statistically significant difference in WBC,COR and CRP between the two groups(P>0.05),and GLU of the observation group was lower than that of the control group(P<0.05).At T2 and T3,WBC,COR,CRP and GLU in the observation group were lower than those in the control group(P all<0.05).At T4 time,there was no statistically significant difference in CD3^(+)andCD4^(+)between the two groups(P all>0.05),and CD4^(+)and CD4^(+)/CD8^(+)in the observation group were higher than those in the control group(P all<0.05).At T5 time,there was no statistically significant difference in CD3^(+),CD8^(+)and CD4^(+)/CD8^(+)between the two groups(P all>0.05),and CD4^(+)in the observation group was higher than that in the control group(P all<0.05).At T6 time,CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in the observation group were higher than those in the control group(P all<0.05).There was no significant difference in CD8^(+)between the two groups(P>0.05).Conclusion Epidural block combined with general anesthesia is better for patients undergoing laparoscopic radical resection of colorectal cancer,which can reduce stress response and improve oxygenation function.