| Objectives To compare the effects of general anesthesia combined with dexmedetomidine and general anesthesia combined with epidural block on the stress response and postoperative recovery of elderly patients undergoing laparoscopic radical resection of colorectal cancer.Methods Selection of North China University of Science and Technology affiliated hospital in November 2017 to October 2018 marked the elderly patients with 60 cases of laparoscopic colorectal cancer radical,age 65 or higher,ASA ? to ? level.According to the random number method,patients were randomly divided into two groups: general anesthesia combined with dexmedetomidine group(group D)and general anesthesia combined with epidural group(group E),with 30 patients in each group.Patients in the general anesthesia combined with dexmedetomidine group(group D)received intravenous infusion of dexmedetomidine at a dose of 0.8 ?g/kg before anesthesia induction,followed by endotracheal intubation 10 min later,followed by intravenous infusion of dexmedetomidine at a rate of 0.5 ?g/kg/h,and drug withdrawal 30 min before surgery.General anesthesia combined epidural group(group E)patients,home invasion by the L1~2 line clearance after epidural puncture,puncture success into epidural catheter after 4 cm,to test 3 ml of 2% lidocaine,in determining the without the whole spinal anesthesia phenomenon after the first dose,2% lidocaine 5 ~7 ml,stay the anesthesia plane basically stable after anesthesia induction,every one hour epidural anesthesia maintenance period to2% lidocaine 50 mg.Under the FloTrac/Vigileo cardiac output monitoring system,intraoperative rehydration with SVV of 8 ~12was performed(the ratio of sodium lactate ringer injection and 6% hydroxyethyl starch 130/0.4 sodium chloride injection was maintained at 2:1).Records in the two groups of the patient's general situation and intraoperative general anesthetics dosage,respectively(T0)prior to the induction,endotracheal intubation(T1),immediately after 5 min after pneumoperitoneum(T2),30 min after pneumoperitoneum(T3),immediately after extubation(T4)extraction of venous blood measure epinephrine(E)and norepinephrine(NE),cortisol(Cor),and the concentration of blood glucose,and postoperative 1 h,6 h,12 h,24 h,48 h,VAS score,exhaust time,eating time,hospitalization days and the related complications.Results Comparison between the two groups: there were no significant differences in gender,age,BMI,ASA classification and other aspects between the two groups(P >0.05).There were no statistical differences in the total amount of anesthetic drugs used during surgery,operation time,blood loss and intravenous fluids.(P >0.05).The concentrations of cortisol,epinephrine and norepinephrine in group D were lower than those in group E at T1 and T2,and the differences were statistically significant(P <0.05).There was no significant difference in the concentrations of cortisol,epinephrine and norepinephrine between the two groups at T0,T3 and T4(P >0.05).There was no significant difference in blood glucose and MAP between the two groups at five time points(P >0.05),and heart rate of group D was significantly slower than that of group E at T2 and T3,with statistically significant difference(P <0.05).There was no significant difference in VAS score,exhaust time,feeding time and hospitalization time between the two groups at different time points of postoperative rest,but in terms of absolute value,group D was superior to group E.(P >0.05).Intra-group comparison: the concentrations of cortisol,epinephrine and norepinephrine in T1,T2,T3 and T4 in group E were all higher than T0,with significant differences(P<0.05).In group E,compared with T0,there were no statistically significant differences in blood glucose,heart rate and MAP at T1,T2,T3 and T4(P>0.05).The concentrations of cortisol,epinephrine and norepinephrine in group D were all higher than T0 at T2,T3 and T4,and the difference was significant(P<0.05).Compared with T0,there was no significant change in the concentrations of epinephrine and norepinephrine at T1(P>0.05).In group D,compared with T0,there were no statistically significant differences in blood glucose and MAP at T1,T2,T3 and T4(P>0.05).At T2 and T3,the heart rate of group D was significantly slower than that of T0,and the difference was significant(P<0.05).Conclusions In laparoscopic radical resection of colorectal cancer in elderly patients,general anesthesia combined with dexmedetomidine has a better inhibitory effect on stress than combined with epidural block,and has more advantages in shortening postoperative exhaust time,feeding time and hospitalization time.Figure 6;Table 8;Reference 135... |
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