| Objective:The monitoring of circulatory function during the perioperative period is an important aspect to ensure the safety of the patients.None of the traditional monitoring devices can achieve the purpose of being continuous,accurate,minimally invasive,safe,and simple at the same time.In recent years,a monitoring device dubbed FloTrac/Vigileo has been applied to operation gradually which has all the above characteristics.Surgeries pose strong stress response and severe fluctuation in the patients with gastrointestinal cancer.In addition,because different anesthetic methods result in different circulatory changes effects,the monitoring of the circulatory changes is necessary and the requirements for hemodynamic monitoring are very high.Therefore,This experiment studies the circulation monitoring using FloTrac/Vigileo monitoring technology on the elderly senile gastrointestinal tumor patients,observes and compares the effects of total intravenous anesthesia combined with epidural(GEA group/experimental group)and total intravenous anesthesia(GA group/control group)on cardiac output and outcome measures,to provide a certain clinical basis for subsequent liquid management research.Methods:Select 40 cases of elderly patients from December 2016 to October 2017 in Affiliated Hospital of Yan’an University undergoing gastrointestinal malignant tumor resection,at the age of 65-79 years old,ASA grade is I-II,were randomly divided into 2 groups: experimental group and control group,all use FloTrac/Vigileo hemodynamic monitoring system monitor circulation,bispectral index monitor BIS value.Among them,the experimental group was anesthetized by intravenous anesthesia combined with epidural anesthesia,and the control group was anesthetized by intravenous anesthesia.Monitor and compare the 2 groups of four hemodynamic indicators: cardiac output(CO),cardiac index(CI),each stroke volume(SV)and stroke volume variation(SVV)at six moment: 10 minutes after lie stretched out and before anesthesia(T0),5 minutes after anesthesia(T1),at the beginning of the operation(T2),10 minutes operation(T3),30 minutes operation(T4)and 1 hour(T5).Results:1.The general data of the two groups such as the gender,age,BMI,ASA classification were not statistically significant(P>0.05),indicating that the two groups had a balanced comparability.2.At the time of T1,CO,CI and SV in the 2 groups were significantly lower than those at T0(P<0.05),indicating that anesthesia induction can significantly reduce the level of CO,CI and SV in the 2 groups.3.The CO,CI and SV at the time of T2 in the GEA group were significantly lower than those in the GA group through inter group comparison(P<0.05),indicating that the epidural combined general anesthesia group had a more stable hemodynamics than general anesthesia group.4.In group GA,CO,CI and SV increased at the time of T2 than T1,T3,T4 and T5(P<0.05).It shows that the operation stimulation of the simple general anesthesia group has a greater influence on the circulation fluctuation of the patients.5.In group GEA,there was no significant difference in CO,CI and SV at the time of T2 with the time of T1,T3,T4 and T5(P>0.05).It shows that the surgical stimulation in combined group did not cause significant change in the hemodynamics of the patients.6.CO,CI and SV had no significant difference intra and inter group comparison at the time of T1,T3,T4 and T5(P>0.05),indicating that the two groups of patients had maintained stable state at the time of 5 minutes after anesthesia,intraoperative 10 minutes,intraoperative 30 minutes and intraoperative 1 hour.7.There was no significant difference in SVV between 2 groups at the same time point(P>0.05),and stroke volume variability did not change significantly,indicating that two groups of patients have a steady state of capacity at any time.Conclusion:The combination of total intravenous and epidural anesthesia poses less influence than total intravenous anesthesia on circulation in elderly patients with gastrointestinal tumor surgery and the hemodynamics is more stable,which is more beneficial to anesthesia management. |
