Effect Of Compound Anesthesia On Microcirculation And Molon HIF-1 In Elderly Patients Undergoing Laparoscopic Radical Resection Of Colon Cancer

Objective To investigate the effect of general anesthesia combined with epidural anesthesia on tissue oxygenation and HIF-1α in patients with laparoscopic radical colorectal cancer,and to investigate whether anesthesia has a perioperative metastasis.The effect is to screen a more reasonable anesthesia for elderly patients with laparoscopic colorectal cancer.Methods According to the unanimous consent of the hospital ethics committee,71 patients who underwent radical laparoscopic colorectal cancer in our hospital from May 2017 to July 2018 were excluded according to the rejection criteria.After the remaining 60 cases,the basic information of the patient was recorded.Patients were randomly divided into group A(epidemic combined general anesthesia group)and group B(general anesthesia group)in 30 cases.The Dukes stage of the two groups were in the A~B stage,and the ASA stage II-III stage did not undergo radiotherapy and chemotherapy before surgery.All subjects underwent rehydration with SVV values of 8-12,10 min before anesthesia(T0),10 min after tracheal intubation(T1),1 h after T5(T2),2 h after T5(T3),MAP,HR,CVP,pneumoperitoneum pressure and airway pressure were recorded at 10 min(T4)after extubation;2 ml of arterial blood was taken at each time point,and HIF-1α(hypoxia-inducible factor 1)in serum was measured at each time point.-α),iNOs(inducible nitric oxide synthase)concentration.In the pathology department of our hospital,the colorectal cancer tissue(central tissue of the cancer)and the normal intestinal tissue(5cm normal intestinal tissue around the cancer)were obtained within 24 hours after operation.HIF-1α was detected by immunohistochemistry.The situation of expression.The CO,CI,and SVV at each time point were recorded by Vigileo observation.In addition,10 ml(T0)before anesthesia,1 h(T2)after pneumoperitoneum,2 h(T3)after pneumoperitoneum and 10 min(T4)after extubation were performed to collect blood gas of arterial blood and central venous blood 1 ml to monitor blood gas,calculate and record OI.(oxygenation index)and ABL(arterial blood lactate).Results Compared with the two groups,the patients were compared in general,and the difference was not statistically significant(P>0.05).Hemodynamic parameters: The heart rate of group B was significantly higher than that of group A at time T2,time T3,andtime T4.The mean arterial pressure of group B was significantly higher than that of group A at time T2,time T3,and time T4;CVP of group B At time T2 and time T3,it was significantly higher than group A;Ppeak of group B was higher than group A at time T3.Compared with the oxygenation index of the two groups,the oxygenation index: the OI at the T0,T2,T3,and T4 levels was not significantly different from the A group(P>0.05);the ABL was higher at the T3 and T4 times.In group A(P<0.05).The expression of HIF-1α in both tissues,in colon cancer tissues,the positive expression rate of HIF-1α in the general anesthesia group was higher than that in the epidural composite general anesthesia group.In normal intestinal tissues,the positive expression rate of HIF-1α in the general anesthesia group was not significantly different from that in the epidural combined general anesthesia group.Compared with the serum indexes of the two groups,the concentration of HIF-1α in the serum of group B was higher than that of group A at T2,T3,T4,and time,P<0.05.The concentration of iNOs in serum of group A was higher than that of group B at T0,P<0.05.Compared with the two groups,the dose of propofol,remifentanil and cis-atracurium in group B was significantly higher than that in group A.The recovery time and extubation time of group B patients were significantly higher than those of group A.Conclusion 1 General anesthesia combined with epidural anesthesia compared with general anesthesia can make patients with more stable hemodynamics.2 General anesthesia combined with epidural anesthesia can make the airway pressure of patients with low-grade pneumoperitoneum more stable and have lung protection.3 General anesthesia combined with epidural anesthesia can improve oxygenation in patients,resulting in decreased expression of HIF-1α.4 General anesthesia combined with epidural anesthesia can reduce the amount of intraoperative medication,shorten the recovery time,and improve the prognosis of patients.Figure 8;Table 10;Reference 128.