Impacts Of Epidural Combined With General Anesthesia On Intestinal Barrier In Elderly Colorectal Cancer Surgery

Objectives To observe and analyze the effects of epidural combined general anesthesia（GEA）and general anesthesia alone（GA）on perioperative intestinal barrier and postoperative intestinal recovery in elderly patients undergoing laparoscopic colorectal cancer surgery,and to explore whether combined anesthesia can better protect intestinal barrier function and postoperative intestinal recovery than general anesthesia alone.Methods From May 2020 to August 2021,83 elderly patients,aged 65-83 years,who were scheduled to undergo laparoscopic radical resection of colorectal cancer or laparoscopic radical resection of colorectal cancer in the Affiliated Hospital of North China University of technology,were selected,and their ASA grade was grade II-III.Random number table method was divided into epidural combined general anesthesia（Group E,n=41）and simple general anesthesia group（Group C,n=42）.The gender,age,BMI and other general data of the two groups were recorded before operation.In the E group,puncture and catheterization were performed in the epidural space before the induction of general anesthesia.0.375%ropivacaine 4-6m L/h was continuously pumped during the operation.The epidural catheter was pulled out after the patient was awake.The induction of general anesthesia was basically the same in the two groups.The same anesthesia depth was maintained under the guidance of bispectral index（BIS）,and the BIS value was maintained at 45-60.The two groups were treated with Flotrac/Vigileo cardiac output monitoring system and 10%±3%stroke variability（SVV）.Heart rate（HR）,mean arterial pressure（MAP）,stroke variability（SVV）,cardiac index（CI）and bispectral index（BIS）were recorded at five time points:10 min after entering the room（T0）,at the beginning of operation（T1）,30 min after pneumoperitoneum（T2）,the lesion in vitro（T3）and at the end of operation（T4）;The concentration of serum diamine oxidase（DAO）,D-lactic acid（D-lac）,interleukin-6（IL-6）,interleukin-10（IL-10）and tumor necrosis factor-α（TNF-α）were measured by enzyme-linked immunosorbent determination;Take 2m L of T0-T4 peripheral arterial blood,and measure the p H value,lac value,SBE value,K⁺concentration and Na⁺concentration of arterial blood gas;2m L of central venous blood was extracted and the central venous oxygen saturation（Scv O₂）was measured;The use of general anesthesia drugs,the use of vasoactive drugs,the amount of in and out during operation,the length of operation,the first postoperative exhaust,the first postoperative eating time,the first postoperative out of bed activity time,the length of hospital stay and postoperative complications were recorded.Results There was no difference between the two groups in general information,operation frequency and bleeding volume（P>0.05）,and there was no difference in the use of vasoactive drugs except urapidil（P>0.05）;The total intraoperative infusion volume and urine volume in Group E were higher than those in group C（P<0.05）,and the unit time consumption of intraoperative narcotic drugs and postoperative extubation time in Group E were lower than those in group C（P<0.05）;From T1-T4,MAP and HR in Group E were lower than those in group C（P<0.05）,and BIS in Group E was higher than those in group C（P<0.05）;From T2 to T4,SVV in Group E was lower than that in group C（P<0.05）,and CI was higher than that in group C（P<0.05）;Compared with DAO and D-Lac in the two groups,group E was lower than group C at T2-T6（P<0.05）;Compared with the blood gas of the two groups,the concentrations of SBE and Lac in Group E at T3-T4 were lower than those in group C（P<0.05）,and the concentrations of Scv O₂ in Group E at T2-T4 were higher than those in group C（P<0.05）;Compared with group C,the concentration of K⁺in Group E was higher in T2-T4,and the concentration of Na⁺in T4 was higher in group C;Inflammatory factors IL-6,IL-10 and TNF-αin group E Compared with group C,group E was lower at T3-T6;The postoperative VAS score of group E was lower than that of group C except that there was no difference in resting vas at T6（P<0.05）;The first postoperative exhaust,first eating,first out of bed activity,length of hospital stay and incidence of postoperative complications in Group E were lower than those in group C（P<0.05）;The time of catheter removal in Group E was higher than that in group C（P<0.05）.Conclusions Epidural combined general anesthesia has the following advantages:1.Make the hemodynamics of patients more stable during operation,ensure tissue perfusion and reduce postoperative complications;2.It can reduce perioperative intestinal barrier injury,protect intestinal function and promote postoperative recovery;3.Maintain the balance of internal environment and electrolyte,and ensure the balance of oxygen supply and demand;4.Reduce inflammatory reaction,reduce the risk of perioperative infection and protect the function of various organs;5.Reduce the medication of general anesthesia,which is conducive to the postoperative recovery of patients.Figure 0;Table 11;Reference 182...