The Effect Of Combined General And Epidural Anesthesia For Abdominal Surgery On Pulmonary Function And Stress Reaction In Elderly

Objective: To observe whether combined general and epidural anesthesia can protect pulmonary function and reduce stress reaction during abdominal surgery in the aged.Methods: 30 patients aged from 60 to 80 with ASA I to III who are ready to accept abdominal operation are divided into 2 groups randomly, group A for combined general anesthesia group and group B for general anesthesia group. Their preoperative mental status is similar; pulmonary infection and respiratory dysfunction do not exist.Epidural block is performed in group A firstly, after block plane comes to the needed level, induction and endotracheal intubation is performed after that. Anesthesia is maintained with propofol and atracurium. PCEA is used in group A postoperatively.In group B, patients receive midazolam, fentanyl and atracurium for induction and followed by endotracheal intubation.Anesthesia is maintained with propofol , fentanyl and atracurium.PCA is used in this group postoperatively.BP,HR, dosage of anesthetics,blood loss, analepsia time are recorded in 6 different points,they are 5 minutes after the patient reach the operation room (T₁) , instantly after anesthesia induction (T₂), instantly after endotracheal intubation (T₃), instantly after cutting the skin (T₄) ,5 minutes before the operation ended (T₅) , instantly after extubation (T₆) .Blood samples are taken at the time instantly after anesthesia induction and instantly after operation to determine the concentration of cortisol and blood glucose.Observe the analgesia in 2 groups and record VAS score.Observe the patients whether they catch pulmonary infection after operation. Measure the patient's pulmonary function the day before the operation and 3 days after the operation.Results:1. There is no significant difference in age,weight,the number of patients who have hypertension and ASA between the 2 groups (P>0.05);2. Time of operation,the blood loss are similar (P>0.05). Compared to group B,the dosage of anesthetics used in group A is obviously less,and analepsia time is less too. (P<0.01)3. Haemodynamics in group A is more stable;4. Compared to group B, postoperative Steward score is higher in group A;5.VAS score in group A is lower than that of group B, it shows that postoperative analgesia in group A is more satisfactory;6. The index of pulmonary function reduces in both groups, but it is more obvious in group B (P<0.01) ;7. 2 patients in group A and 3 in group B caught postoperative pulmonary infection;8.There is no changes in concentration of blood glucose and cortisol in group A,but the 2 indexes get higher after operation in group B.Conclusion: Combined general and epidural anesthesia can reduce the stress reaction during operation and protect pulmonary function.