全身麻醉联合硬膜外麻醉对老年结直肠癌根治术患者组织灌注及肠道屏障的影响  

Effect of general anesthesia combined with epidural anesthesia on tissue perfusion and intestinal barrier in elderly colorectal cancer patients undergoing radical resection

作　　者：马松梅[1] 孔莉[1] 方传奇[1] Ma Songmei;Kong Li;Fang Chuanqi(Department of Anesthesiology,Shangqiu First People's Hospital,Shangqiu 476100,China)

机构地区：[1]商丘市第一人民医院麻醉科,商丘476100

出　　处：《中华老年医学杂志》2021年第1期102-106,共5页Chinese Journal of Geriatrics

摘　　要：目的探讨全身麻醉(全麻)联合硬膜外麻醉对老年结直肠癌根治术患者组织灌注及肠道屏障的影响。方法选择我院2018年1月至2019年9月收治的118例结直肠癌老年患者为研究对象,应用随机数表法分为2组,各59例。两组患者均行结直肠癌根治术,对照组麻醉方案为全麻,观察组为全麻联合硬膜外麻醉。对比围术期两组组织灌注[中心静脉-动脉二氧化碳分压差值(Pcv-aCO2)、氧供指数(DO2I)、氧耗指数(VO2I)、中心静脉-动脉乳酸差值(Dcv-aLac)、氧摄取率(O2ER)、中心静脉氧饱和度(ScvO2)]及肠道屏障[二胺氧化酶(DAO)、D-乳酸(D-Lac)]情况。结果相较于对照组,观察组T2-T4 ScvO2均较高,T1-T4 VO2I、Dcv-aLac、Pcv-aCO2均较低(P<0.05);观察组T1-T4 DO2I略高于对照组,O2ER略低于对照组,但差异均无统计学意义(均P>0.05);两组D-Lac、DAO从T1-T5呈逐渐升高趋势,T5-T6呈下降趋势,且与对照组相比,观察组D-Lac、DAO在T2-T6时间段较低(P<0.05)[腹部探查时(T1);病灶离体(T2);关腹前(T3);术毕(T4);术后第1 d(T5);术后第3 d(T6)]。结论老年患者在全麻联合硬膜外麻醉情况下开展结直肠癌根治术更利于稳定患者围术期组织灌注,有效降低肠道屏障损伤,利于提高麻醉效果。Objective To investigate the effect of the combined general and epidural anesthesia on tissue perfusion and intestinal barrier in elderly patients undergoing radical resection of colorectal cancer.Methods A total of 118 elderly patients with colorectal cancer admitted to our hospital from January 2018 to September 2019 were randomly divided into two groups:a single general anesthesia(control,n=59)and combined general and epidural anesthesia(observation,n=59).Two groups underwent radical resection of colorectal cancer.The perioperative parameters were compared between the two groups,including tissue perfusion[central venous-to-arterial carbon dioxide difference(Pcv-aCO2),oxygen delivery index(DO2I),oxygen consumption index(VO2I),difference between central venous and arterial lactate(Dcv-aLac),oxygen extraction rate(O2ER),central venous oxygen saturation(ScvO2)],and intestinal barrier[diamine oxidase(DAO),D-lactic acid(D-Lac)].Results Compared with the control group,the ScvO2 during T2-T4 periods was increased in the observation group,and the VO2I,Dcv-aLac and Pcv-aCO2 during T1-T4 periods were reduced in observation group(P<0.05).The DO2I during T1-T4 periods was slightly higher in the observation group than in the control group,and the O2ER was slightly lower in the observation group than in the control group,but the differences were not statistically significant,(P>0.05).In the both two groups,the D-Lac and DAO levels showed a gradual upward trend during T1-T5 periods and a gradual downward trend during T5-T6 periods.The D-Lac and DAO levels during T2-T6 periods were lower in observation group than in the control group(P<0.05)[during abdominal exploration(T1);invitrolesion(T2);before abdominal closure(T3);after surgery(T4);postoperative day 1(T5);postoperative day 3(T6)].Conclusions General anesthesia combined with epidural anesthesia in elderly colorectal cancer patients undergoing radical resection can stabilize perioperative tissue perfusion,decrease intestinal barrier injury and increase anesthetic effect.

关 键 词：结直肠肿瘤 麻醉全身 外麻醉硬膜 肠道屏障 

分 类 号：R614[医药卫生—麻醉学] R735.34[医药卫生—外科学]