Effects Of Combination Anesthesia On Cardiac Protrction In Elderly Hypertensive Patients With Colorectal Surgery

Objectives To observe the effects of combination anesthesia on cardiac function in elderly hypertensive patients with colorectal surgery.Methods In March 2017 to July 2017,sixty elderly patients from The Affiliated Hospital of North China University of Science and Technology,who were scheduled to receive colorectal surgery,were randomly divided into Group GA(general anesthesia)and Group GEA(combination anesthesia)according to random number table,each group for 30 cases with American Society of Anesthesiology ?~ ? level.After entering the operation room,Group GEA were inserted by epidural puncture,tested the anesthetic level within the range of T6-T12.The two groups had same anesthesia induction program,continuous infusion of propofol 4~6mg/(kg�h)and remifentanil 0.1~0.2?g/(kg�min)during operation.Used cisatracurium besylate 0.05mg/kg discontinuously to maintain muscle relaxation.0.25% ropivacaine 50 mg was supplemented via epidural catheter on skin suture in Group GEA.Uesd GDFT to guide infusion.Controlled the bispectral index within 40~60.Recorded the index of HR,MAP,BIS at enter the operation room with 5 minute oxygen inhalation(T0),tracheal intubation(T1),skin inoision(T3),resection of the lesion(T4),the end of operation(T5),5 minutes after extubation(T6).Recorded CO,CI,SV,SVI,SVV,SVR,SVRI at T3,T4,T5.Recording the amount of crystal liquid,colloidal liquid,total infusion volume,the dosage of propofol and remifentanil,bleeding,urine output,operation time,waking time,extubation time,agitation in the extubation time during awaking period,SAS score,VAS score in 4 hour and 24 hour after operate,the restart of anal exhaus,postoperative hospital stay,complications of cardiovascular system.Extract 2ml of central venous blood extraction to determination the concentration of cTnI,NT-pro BNP in T1,4 hour and 24 hour after operate.Results The age,gender,BMI,ASA level,bleeding,urine output,operation time,vasoactive drugs had no significant differences(P>0.05).But waking time,extubation time,restart of anal exhaus,postoperative hospital stay of Group GEA were faster(P<0.01).More crystal liquid,and less colloidal liquid were used in Group GEA(P<0.05).The dosage of propofol and remifentanil in Group GEA was less(P<0.05).The SAS score was no significant differences(P>0.05).In Group GA,the VAS score in 24 hour after operate was less than that in 4 hour after operate,and no significant differences(P>0.05)in Group GEA.Group GEA was better in 4 hour after operate(P<0.01),no significant differences between them in 24 hour after operate.Compared with T1,the concentration of cTnI and NT-proBNP in 4 hour and 24 hour after operate were increased(P<0.01).The concentration of NT-pro BNP in 4 hour after operate was lower in Group GEA(P<0.05),both of them were lower than Group GA in 24 hour after operate.Compared with T1,HR were increased in T2(P<0.01),and decreased in T3,T4,T5(P<0.01).Between the two groups,Group GEA was lower in T6(P<0.05).Compared with T1,MAP of Group GEA decreased in T2~T5(P<0.01),MAP of Group GA decreased in T2~T6(P<0.01).Between the two groups,Group GEA was lower in T2~T6(P<0.01 or P<0.05).Compared with T1,BIS of all patients were decreased in T2~T6(P<0.01).Between the two groups,Group GEA was higher in T5,T6(P<0.05).Compared with T1,CVP of Group GA decreased in T2(P<0.01),gradually increased in T3,and higher than T1 in T4~T6(P<0.01 or P<0.05).CVP of Group GEA decreased in T2(P<0.01),gradually increased in T3,and higher than T1 in T3~T6(P<0.01 or P<0.05).Between the two groups,Group GEA was higher in T3(P<0.05).Compared with T3,there was no significant differences(P>0.05)in Group GA of SV and SVI.SV and SVI of Group GEA were increased in T4,T5(P<0.01).SVV of the two groups was decreased(P<0.01 or P<0.05).CO of Group GEA was no significant differences(P>0.05).CO of Group GA was increased in T5(P<0.05).CI of the two groups was no significant difference(P>0.05).SVR and SVRI of Group GA were no significant differences(P>0.05).SVR and SVRI of Group GEA were decreased in T5(P<0.05).Between the two groups,there were no significant differences(P>0.05)in SV,SVI,SVV,CO,CI.SVR,SVRI were lower in Group GEA(P<0.05).Conclusions Under the same surgical effect,for elderly hypertensive patients with colorectal surgery,combination anesthesia decrease the systemic vascular resistance,and linked to heart protective.It can make anesthesia drugs more scientific,shorten the recovery time,better for postoperative sedation and pain control.