| ObjectiveTo explore the protective effects of epidural block combined with general anesthesia on myocardial cell in elderly patients with hypertension undergoing thoracic-laparoscopic esophageal cancer surgery by observing perioperative hemodynamics,myocardial injury indicators,revival quality and arterial blood gas analysis results.MethodsEighty elderly patients with hypertension undergoing selective thoracic-laparoscopic esophageal cancer surgery,aged from 65 to 80 years old,ASA ?-?,were randomly divided into two groups,group GA?general anesthesia?and group GEA?epidural block combined with general anesthesia?.Preoperative fasting was executed for 8-12 hours,regular use of antihypertensive drugs,preoperative systolic blood pressure control in 160-120 mmHg,diastolic blood pressure control in 80-90 mmHg.All patients were premedicated with phenobarbital 0.1g and atropine 0.5mg intramuscularly 30 min before anesthesia induction.Patients were monitored with BP,HR,SpO2,ECQ BIS with inhaling oxygen.Opening venous access and monitoring CVP by right internal jugular vein puncture and catheterization,and monitoring invasive arterial pressure by left radial artery puncture and catheterization under local anesthesia.Epidural catheterization was performed in group GEA between T9 and T10,and 2%hdocaine 5ml test dose was injected.After no complications,0.25%ropivacaine 8-10ml was given to control plane T4-T10.Dexamethasone lOmg,midazolam 0.03-0.05mg/kg,fentanyl 2-4ug/kg,propofol 1-2 mg/kg and cisatracurium 0.15 mg/kg were used in both groups for rapid intravenous induction and single-lumen tracheal tube placement.In both groups,propofol 4-6mg·kg-1·h-1,remifentanil 0.1-lmg·kg-1·h-1,cisatracurium 0.1-lmg·kg-l·h-1,sevoflurane 1-2%continuous inhalation,maintaining the depth of anesthesia with BIS at 40-60,arterial blood pressure fluctuation within 20%of baseline blood pressure.Epidural administration of 0.25%ropivacaine 5 ml every 1 hour in group GEA.Cisatracurium and sevoflurane were discontinued 20 minutes before the end of operation,propofol and remifentanil was discontinued during suture,neostigmine 0.02mg/kg+atropine 0.01 mg/kg was given at the end of suture,and sputum was sucked to clear the respiratory tract and oral cavity.Pull out tracheal tube and transfuse patients to PACU.50mg flurbiprofen axetil was injected intravenously at the beginning of surgery and 10 minutes before the end of the seam.Sufentanil 3ug/kg+flurbiprofen axetil 100mg+tropisetron 10mg was used for postoperative analgesia.Data recording nodes were befor anesthesia?T0?,endotracheal intubation?T1?,at the beginning of surgery?T2?,2h after the beginning of surgery?T3?,at the end of surgery?T4?,extubation?T5?,1h after operation?T6?,24h after operation?T7?,48h after operation?T8?.SBP,DBP,HR,CI were recorded at T0,T1,T2,T4,T5,T6;Lac,Glu and PaCO2 were recorded at T0,T2,T3,T4,T6;cTnI,CK,CK-MB,LDH,AST and NT-proBNP were recorded at T0,T6,T7,T8;VAS was recorded at T6,T7,T8;at the same time,the delay of recovery,total use of remifentanil,postoperative agitation,incidence of pulmonary infection during hospitalization,and the number of hospital stays were observed.Cardiac and pulmonary complications were followed up at 3 months and 6 months after surgery.Result1.Change of SBP,DBP,Cl,HR:Compared with group GA,SBP and DBP,CI in group GEA were decreased significantly and HR were slowed down significantly at T2 and T5?P<0.05?.2.Change of cTnI,CK,CK-MB,LDH,AST,NT-proBNP,Glu,Lac,PaCO2:2.1 Intragroup comparison:2.1.1 cTnI was negative at T0,T6,T7,T8 in both groups.2.1.2 The CK,CK-MB and LDH at T6,T7 and Ts in group GA and group GEA were respectively significantly higher than those at T0?P<0.05?.2.1.3 The AST in group GA at T6 and T7 were significantly higher than those at T0?P<0.05?,the AST in group GEA at T6,T7 and T8 were significantly higher than those at T0?P<0.05?·2.1.4 The NT-proBNP in group GA and group GEA at T7 and T8 were respectively significantly higher than those at T0?P<0.05?.2.2 Intergroup comparison:2.2.1 There was no significant difference in CK,Lac and PaCO2 among groups at different time points?P>0.05?.2.2.2 At T6 and T7,the NT-proBNP and the CK-MB in group GEA were significantly lower than those in group GA?P<0.05?.2.2.3 At T6,T7 and T8,the AST and the LDH in group GEA were significantly lower than those of group GA?P<0.05?.2,2.4 At T2 and T6,the Glu in group GEA was significantly lower than that in group GA?P<0.05?.3.Comparisons of the total use of remifentanil and hospitalization days:compared with the group GA,the total use of rernifentanil and hospitalization days in group GEA decreased?P<0.05?4.Comparison of VAS:4.1 Intragroup comparison:the VAS of the two groups at T6 and T7 were respectively significantly higher than those at T8?P<0.05?.4.2Intergroup comparison:At T6 and T7,the VAS of group GEA was significantly lower than that of group GA?P<0.05?.5-Comparison of recovery quality and follow-up index after operation:compared with the group GA,the incidence of postoperative agitation in group GEA was significantly lower?P<0.05?.There was no significant difference between the two groups in recovery delay,incidence of pulmonary infection during hospitalization and adverse events of cardiopulmonary system?P>0.05?.ConclusionsEpidural combined general anesthesia makes perioperative hemodynamics more stable in elderly patients with hypertension undergoing thoracic-laparoscopic esophageal cancer surgery,reduces stress response,can effectively suppress the increase in NT-proBNP,CK-MB,AST,LDH,may be beneficial in myocardial protection,reduces the amount of opioids used during surgery and incidence of postoperative agitation,provides better postoperative analgesia,accelerates rapid recovery of patients,reduces the incidence of long-term cardio-pulmonary complications. |
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