The Clinical Study Of Different Inhalation Anesthetics On Hemorheology In Patients With Digestive Tract Malignant Tumors

Objective:To observe the effection of isoflurane or sevoflurane inhalation anesthesia on hemorheology in patients, seprated in different age groups, with digestive tract malignant tumors, and provide a basis for clinical inhalation anesthetics selection through comparing and analyzing the results.Methods:60 patients (male 33, female 27, aged 35-71 years old), ASAⅠ～Ⅱclass, with gastric cancer, colorectal cancer or colon cancer were treated with elective radical surgery. The patients were divided into old age group (age≥65 years old) and young adults group (aged< 65 years old) according to their ages. These two groups were also divided into two groups of isoflurane and sevoflurane groups in line with the inhalation anesthesia drugs. Anesthesia procedures:imidazole alprazolam 0.04mg.kg-1, fentanyl 2ug.kg-1, propofol 2mg.kg-1, vecuronium 0.1mg.kg-1 were intravenous injected successively for rapid induction, followed by endotracheal intubation, Ohmeda 80-type anesthesia machine was used to control breathe. Isoflurane (0.5-1L.min-1) or sevoflurane (0.5～1L.min-1) was inhalated continuously, remifentanil 0.05-0.2 ug.kg-1.min-1 and vecuronium lug.kg-1.min-1 were intravenous pumped to maintain anesthesia, adjusting the dosage according to Bis, TOF, blood pressure and heart rate. Uniform application of lactate Ringer's solution and 6% of hydroxyethyl starch(ratio of 1:1) for intraoperative transfusion at the speed of 12-15ml. kg-1, h-1,5 ml blood were drawn respectively in all patients at four time points:before the infusion of anesthesia, reached to MAC 1-1.3 hours and maintained 1 hour, stopping inhalation anesthesia, into the PACU 30 minutes to measure hematocrit (Hct) and erythrocyte sedimentation rate (ESR). Fast Automatic Blood test instrument was used to measure the high-shear whole blood viscosity (Hηb), the middle-shear whole blood viscosity (Mηb), low-shear whole blood viscosity (Lηb)and plasma viscosity (ηp). Applicating FASCO-3010 blood rheological analysis software to restore the calculation of whole blood viscosity (ηr), erythrocyte aggregation index (EAI), red blood cell deformability index (EDI), erythrocyte rigidity index (ERI), and ESR-K and other blood rheology.Results:(1) anesthesia before surgery, the values of Hηb, Mηb, Lηb, EAI, ERI, EDI, and ESR-K between young adults group and old group showed no statistical difference. Compared with young adults group, the values of old group were higher (P<0.05). (2) MAC reach 1-1.3 hours and maintained 1 hour, in young adults isoflurane group, aboutηr, compared with TO, the value in T1 significantly decreased (P<0.05); aboutηp, compared with T3, the value in T1 significantly decreased (P<0.05). In young adults sevoflurane group, about Hηb, Mηb, Lηb,ηr,ηp, ERI, compared with T0, the value in T1 significantly decreased (P<0.05). In old sevoflurane group, about Hηb, Mηb, Lηb,ηr, EAI, compared with TO, the value in T2 significantly decreased (P<0.05); Mηb, Lηb,ηr, EDI, compared with T3, the value in T1 significantly decreased (P<0.05). Compared with young adults isoflurane group, the value of Hηb, Mηb, Lηb,ηr,ηp, ERI significantly decreased (P<0.05) in young adults sevoflurane group; Compared with young adults isoflurane group, the value ofηr and ERI significantly inecreased (P<0.05) in elderly isoflurane group, while EDI significantly decreased (P<0.05). Ending of inhalation anesthesia, in young adults isoflurane group,compared with T3, the value ofηr andηp in T2 significantly decreased (P<0.05), while compared with T0, the value ofηr in T2 significantly decreased (P<0.05). In young adults sevoflurane group, compared with TO the value of Hηb, Mηb, Lηbηr significantly decreased in T2 (P<0.05). In old isoflurane group, compared with TO the value of Mηb, Lηb, ESR-Ksignificantly decreased (P<0.05) in T2. In old sevoflurane group, compared with TO the value of Mηb, Lηb, ESR-K significantly decreased (P<0.05) in T2; compared with T2 the value ofηr,ηp significantly increased (P<0.05) in T3. Compared with young adults sevoflurane group, the value of Hηb, Mηb, Lηb,ηr,ηp, ERI and EAI were significantly lower in young adults isoflurane group (P<0.05); compared with young adults sevoflurane group, the value of Hηb,ηp, ERI were significantly higher (P<0.05) in elder sevoflurane group; Compared with young adults isoflurane group, the value of Mηb, Lηb,ηr,ηp, EAI were significantly higher (P<0.05) in young adults isoflurane group. (4)30min after entering the PACU, in young adults isoflurane group, compared with T2 the value ofηr,ηp were significantly higher (P<0.05) in T3. In young adults sevoflurane group, compared with TO the value of Hηb, Mηb, Lηb significantly decreased (P<0.05) in T3; compared with T2 the value of Hηb, Mηb, Lηb,ηr significantly increased(P<0.05) in T3.In old isoflurane group, compared with T2 the value ofηp increased significantly(P<0.05) in T3. In old sevoflurane group, compared with T1 the value of Mηb, Lηb reduced significantly (P<0.05) in T3, while EDI increased(P<0.05); compared with T2 the value ofηr andηp increased (P<0.05). Compared with the old sevoflurane group, the valve of Hηb, Mηb, Lηb,ηr,ηp, ERI, EAI were lower in young adults sevoflurane group(P<0.05); comparison between young adults sevoflurane group and isoflurane group, the valve of Hηb, Mηb, Lηb, EAI,ηp were significantly lower in former (P<0.05).Conclusion:(1) Both sevoflurane anesthesia and isoflurane anesthesia could improve plasma viscosity in a certain extent, however in some parameters, sevoflurane anesthesia was better than isoflurane anesthesia in improving blood viscosity; (2) In early postoperative time, all of the blood viscosity indicators were colsed to the level of the beginning of anesthesia. (3) This study suggested that in older patients with malignant tumor in gastrointestinal tract, the hemorheology needed to be monitored intraoperative and early postoperative periods, if necessary, viscosity-decreasing depolymerization drugs should be applied to reduce the incidence of deep venous thrombosis.