| Objective To investigate the effect of different anesthesia methods and depth on cellular immune function in elderly patients undergoing laparoscopic colon cancer surgery.Methods Eighty elderly patients undergoing elective colon cancer surgery under general anesthesia in the Affiliated Hospital of North China University of Technology from November 2017 to November 2018 were selecte.Eighty patients were randomly divided into two groups: group A(epidural combined general anesthesia group)and group B(simple general anesthesia group),40 cases in each group.Then group A was divided into group S(shallow anesthesia group,BIS 50-59)and group D(deep anesthesia group,BIS 40-49),20 cases in each group.Recording and analysis of two groups of patients before anesthesia(T0),after tracheal intubation(T1),at the end of operation(T2),one day after operation(T3),three days after operation(T4),seven days after operation(T5),hemodynamics at six time points and a sample of central venous blood(4ml)were put into anticoagulant tube.Flow cytometry was used to detect the percentage of CD4,CD8 and PD1 activity at each time within 24 hours.At the end of the operation,the amount of bleeding,urine,infusion and extubation time were recorded.Results 1There was no significant difference in gender,age,ASA grade and Dukes stage(P > 0.05).2 There was no significant difference in operation time,bleeding volume,urine volume and total liquid volume(P > 0.05).3 The extubation time of group A was shorter than that of group B,and the difference was statistically significant(P < 0.05),and the extubation time of group S was shorter than that of group D.4 Compared with T0,HR and MAP in group A and B decreased in T1 and T2,with statistical significance(P < 0.05).There was no significant difference between T3 and T5(P > 0.05).There was no significant difference in HR and MAP between groups A and B in T0 and T3-T5(P > 0.05).HR and MAP in group A at T1 and T2 were lower than those in group B(P < 0.05),and the difference was statistically significant(P < 0.05).Comparison between S and D groups: HR and MAP of S and D groups at T1 and T2 were higher in S group than in D group,with statistical significance(P < 0.05).5There was no significant difference in CD8 between groups A and B(P > 0.05).Compared with group A and B,CD4 and CD4/CD8 in group A decreased from T1 to T3 at time T0,and decreased most significantly at time T2(P < 0.05);there was no significant difference at time T4(P > 0.05);and there was significant difference at time T5(P < 0.05).In group B,T1-T4 was lower than that at T0,and the most obvious was at T2(P < 0.05),while there was no significant difference at T5(P > 0.05).The difference between group A and group B was statistically significant(P < 0.05)when T1 ~ T5 was higher in group A than in group B.There was no significant difference between S and D groups(P > 0.05).Compared with group A and B,PD1 in group A increased from T1 to T3 at T0(P < 0.05),T4 and T5 had no significant difference(P > 0.05),and T5 had significant difference(P < 0.05).Compared with the time of T0,the time of T1-T4 in group B increased significantly(P < 0.05),and the time of T5 had no statistical significance(P > 0.05).The difference between group A and group B was statistically significant(P < 0.05),and there was no significant difference between group A and group B at T1-T4(P > 0.05).There was no significant difference between S and D groups(P > 0.05).Conclusion Compared with the simple general anesthesia group,the combined epidural general anesthesia group of elderly patients undergoing laparoscopic colon cancer surgery has more stable HR and MAP during the operation,less influence on the perioperative cellular immune function,and is more suitable for protecting the cellular immune function of cancer patients after operation.Maintaining a deeper depth of anesthesia can reduce the hemodynamic fluctuations in elderly patients and be beneficial to elderly patients.Figure 12;Table 6;Reference 102... |
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