Effect Of Combined Anesthesia On Intestinal Barrier In Elderly Patients With Colon Cancer Surgery

Objectives Through the establishment of pure general anesthesia and general anesthesia combined epidural anesthesia,two different models of anesthesia,compare different ways of anesthesia,intraoperative tissue perfusion in patients with senile colorectal cancer radical and the effects of oxygen supply and demand balance,to further explore general combined epidural anesthesia,whether in elderly patients with colon cancer,intestinal barrier function plays a protective role.Methods Choose between January 2017 and July 2017,ASA class ? ~ ?,in the North China University of Science and Technology affiliated hospital,60 patients aged 65-88 years old and underwent radical resection of colorectal cancer were randomly divided into general anesthesia group(GA group n = 30)and general anesthesia combined epidural anesthesia group(GE group n = 30).The patients in GE group were treated with epidural puncture in L1-2 intervertebral space and 0.25% ropivacaine was injected from epidural catheter according to 5ml/h.The induction of general anesthesia was basically the same between the two groups,bispectral index(BIS)control between 40 and 65,GA group of patients with postoperative were given intravenous analgesia(PCIA),GE group of patients with postoperative adopt automatic control epidural analgesia(PCEA);Patients with preoperative record general information,all patients were with Flo Trac/Vigileo cardiac output monitoring system,according to the stroke volume variation(SVV)10±2 as a guiding purpose for rehydration,respectively in the oxygen chamber after 5 min(T0),peering into the abdominal cavity(T1),the lesion in vitro(T2),peritoneal(T3),before the end of the surgery(T4),records the heart rate(HR),mean arterial pressure(MAP),central venous blood oxygen saturation(Scv O2),stroke volume variation(SVV),cardiac index(CI),bispectral index(BIS),etc.Extract T0 ~ T4 center venous blood and peripheral blood line 2 ml of blood gas analysis,and calculate the central venous-toarial difference of carbon dioxide(Pcv-a CO2),difference between central venous and arterial lactate(Dcva Lac),and the oxygen supply index(DO2I),oxygen consumption index(VO2I)and oxygen uptake rate(O2ER)were calculated by vigileo derivatization.Extracting T0~T4 and postoperative day 1(POD1),postoperative day 3(POD3),2 ml central venous blood by using enzyme-linked immunosorbent determination of detection in the serum diamine oxidase(DAO),D-lactic acid concentration;Records of two groups of patients with intraoperative vascular active drug usage,liquid discrepancy condition,operation time,exhaust time,length of hospital stay and the POD1 and the POD3 of visual analogue scale(VAS)pain,postoperative complications and follow-up.Results There was no difference in general information and vasoactive drug usage between GA group and GE group(P>0.05).In the two groups,the amount of liquid input,the input of colloid liquid,and the total amount of liquid were less than that in group GA(P<0.05),and there was no difference in the amount of bleeding and urine of two groups(P>0.05).The MAP and HR of the GE group were lower than the GA group(P<0.05)at the T1-4 time.There was no difference between the two groups in CI and SVV(P>0.05).At the T1-4 time,the GE group BIS values were higher than GA group(P<0.05).The Scv O2 of the two groups showed no difference at T0 and T1(P>0.05),at the T2-4 time,the GE group was higher than the GA group(P<0.05).There was no difference in DO2 I and O2 ER in the two groups(P>0.05).The VO2 I of the GA group was significantly lower than that of GE group at T1-4 time.The Pcv-a CO2 and Dcv-a Lac of the GE group were lower than the GA group at the T1-4 time(P<0.05).In the two groups,D-lactic acid and DAO,at T0 and T1(P>0.05),at T2-4 time,POD1 and POD3,the GE group were all lower than the GA group(P<0.05).On the POD1 and the POD3 VAS score of the two groups,the GE group were lower than the GA group(P<0.05).The GE group of exhaust time and length of hospital stay were significantly lower than that of the GA group(P<0.05).Conclusions 1 Compared with the simple general anesthesia group,general anesthesia combined with epidural anesthesia can better maintain the stability of hemodynamics in the operation and maintain the stability of tissue perfusion.2 Compared with the simple general anesthesia group,general anesthesia combined with epidural anesthesia can better protect the oxygenation of tissues and organs,thus improving the balance of oxygen supply and demand in elderly patients with colorectal cancer.3 Compared with the simple general anesthesia group,general anesthesia combined with epidural anesthesia group can reduce the damage of intestinal barrier function,reduce the incidence of postoperative complications and improve the prognosis of patients.