Comparison Of Dexmedetomidine And Epidural Anesthesia On Stress And Immune Function In Elderly Patients Undergoing Radical Gastrointestinal Cancer

Objective By comparing the anti-stress effects of dexmedetomidine or epidural anesthesia on radical gastrointestinal cancer resection under general anesthesia in the elderly,as well as the effects on immune function,the optimal anesthesia implementation scheme was selected to achieve the purpose of accelerating the recovery of the elderly Methods From May 2018 to June 2019,90 patients underwent laparoscopic gastrointestinal cancer radical surgery under epidural anesthesia in our hospital were divided into 3 groups by random number method: general anesthesia group(group C),dexmedetomidine + general anesthesia group(group D),epidural + general anesthesia group(group E),there were 30 cases in each group.The three groups of patients were recorded before the operation(T0),before tracheal intubation(T1),after pneumoperitoneum(T2),30 minutes before the end of the operation(T3),and at the end of the operation(T4)the patients' mean arterial pressure(MAP)and Heart rate(HR),serum norepinephrine(NE)concentration,serum cortisol(COR)concentration,straight tumor erythrocyte rosette rate(DTER)and immune adhesion inhibitory factor(FEIR)were compared between groups.The operation time,bleeding volume,time of first anal exhaustion,time of first out of bed activity,intraoperative use of vasoactive agents,VAS pain score within three days after operation,incidence of postoperative respiratory depression,incidence of postoperative nausea and vomiting and postoperative hospital stay were recorded in each group.Results The MAP and HR of the three groups were compared.There was no significant difference between the MAP and HR of the three groups at time T0(P>0.05).Compared with group C,MAP and HR at T1,T2,T3,and T4 in Group D were significantly reduced(P <0.05),and HR at T1,T2,T3,and T4 in Group E were significantly reduced(P <0.05);Compared with group T0,the MAP and HR levels at group T3 at group C increased significantly(P <0.05),the MAP and HR groups at group T1,T2,T3,and T4 decreased significantly(P <0.05),and group E at T1 and T2,HR at time T3,T4 was significantly decreased(P <0.05);compared with group D,MAP and HR at time T1,T2,T3,T4 in group E were significantly increased(P <0.05).There was no significant difference in NE,COR,DTER and FEIR levels in groups D and E at T0,T1,T2,T3 and T4(P> 0.05).Compared with T1,NE and COR of Group C increased significantly from time T2 to T4,and DTER and FEIR levels decreased significantly(P <0.05).Groups D and E showed significant NE and COR from time T2 to T4.Lower than group C,DTER and FEIR levels were significantly higher than group C(P <0.05).Before surgery,there was no significant difference in VAS scores between the two groups(P> 0.05).The VAS scores of the three groups C,D and E on the 1st postoperative day,2nd postoperative day and 3rd postoperative day were significantly lower than those before the operation(P <0.05).The VAS scores of Group D and Group E on the 1st day,the second day after operation,and the third day after operation were significantly lower than those of Group C(P <0.05),and there was no significant difference in the VAS scores of Group D and Group E at various time points(P > 0.05).There was no significant difference between group D and group E in terms of operation time,total blood loss,anal exhaust time,first time out of bed activity,intraoperative use of vasoactive agents,VAS pain score within 3 days after surgery,incidence of postoperative respiratory depression and postoperative hospital stay(P> 0.05).Group D incidence of postoperative nausea and vomiting was significantly lower than that of group E(P < 0.05),The operation time,total blood loss,anal exhaust time,the first time out of bed activity,intraoperative use of vasoactive agents,VAS pain score within 3days after surgery,the incidence of postoperative respiratory depression,and thepostoperative hospital stay in Group D and Group E were significantly lower than those in Group C(P <0.05).Conclusion Dexmedetomidine and epidural anesthesia can effectively suppress the stress response,improve immune function,and effectively maintain hemodynamic stability in elderly patients undergoing radical laparoscopic gastrointestinal cancer surgery under general anesthesia.Compared with general anesthesia combined with epidural anesthesia,dexmedetomidine is simple to operate,and the incidence of postoperative nausea and vomiting is significantly reduced,providing patients with the possibility of medical comfort.