摘要
目的探讨静脉复合硬膜外麻醉对老年胃癌合并冠心病患者腹腔镜手术围术期血流动力学指标及心脏功能和免疫功能的影响。方法选取山西省肿瘤医院2017年1月至2021年6月收治的接受腹腔镜胃癌根治术的老年胃癌合并冠心病患者94例, 采用随机信封抽签法分为全凭静脉麻醉组(对照组)和静脉复合硬膜外麻醉组(观察组), 各47例。比较两组患者的血流动力学指标、心脏功能、免疫功能、疼痛评分及镇静评分。结果建立气腹时(T_(1))和术中游离胃左动脉即刻(T_(2)), 观察组患者收缩压分别为(136.6±9.9)mmHg(1 mmHg=0.133 kPa)、(133.9±9.4)mmHg, 舒张压分别为(74.6±4.6)mmHg、(80.7±6.0)mmHg, 心率分别为(79.8±4.0)次/min、(80.9±2.7)次/min;对照组患者收缩压分别为(159.3±7.6)mmHg、(162.5±8.5)mmHg, 舒张压分别为(91.2±5.2)mmHg、(88.3±4.7)mmHg, 心率分别为(106.2±3.3)次/min、(101.9±4.0)次/min;与同时间点对照组相比, 观察组患者血压较低、心率较慢(t值分别为4.25、2.53、6.40、6.81、1.85、1.35, 均P<0.05)。术后12 h(T_(4))时, 对照组患者血液中心肌肌钙蛋白和肌酸激酶同工酶浓度分别为(0.143±0.052)ng/ml、(5.65±0.77)mg/L, 均高于观察组[(0.098±0.015)ng/ml、(3.08±1.06)mg/L](t值分别为4.32、10.19, 均P<0.05)。观察组患者术中血管活性药物使用率和心电图异常发生率分别为19.1%(9/47)和25.5%(12/47), 均低于对照组[48.9%(23/47)和55.3%(26/47)](χ^(2)值分别为8.49、8.66, 均P<0.05)。对照组患者术后3天(T_(6))与术前1天(T_(5))相比CD4+ T细胞比例升高, CD8+ T细胞比例降低(均P<0.05)。观察组术后12 h(T_(4))和术后1天(T_(7))疼痛评分及镇静评分比对照组更优(均P<0.05)。结论老年胃癌合并冠心病患者采用静脉复合硬膜外麻醉进行腹腔镜下胃癌根治术可获得更好的麻醉效果, 并可为患者心脏功能及免疫功能提供更好的保护。
Objective To explore the effects of intravenous combined epidural anesthesia on perioperative hemodynamic indexes,cardiac function and immune function during laparoscopic surgery in elderly gastric cancer patients complicated with coronary heart disease.Methods A total of 94 elderly gastric cancer patients with coronary heart disease who were admitted to Shanxi Province Cancer Hospital from January 2017 to June 2021 were selected.They were divided into the total intravenous anesthesia group(control group)and intravenous combined epidural anesthesia group(observation group)by random envelope lottery,with 47 cases in each group.Hemodynamic indexes,cardiac function,immune function,pain and sedation scores were compared between the two groups.Results When pneumoperitoneum was established(T1)and the left gastric artery was immediately free during operation(T2),systolic blood pressure in the observation group was(136.6±9.9)mmHg(1 mmHg=0.133 kPa)and(133.9±9.4)mmHg,and diastolic blood pressure was(74.6±4.6)mmHg and(80.7±6.0)mmHg;heart rate was(79.8±4.0)times/min and(80.9±2.7)times/min,respectively.The systolic blood pressure of the control group was(159.3±7.6)mmHg and(162.5±8.5)mmHg,and the diastolic blood pressure was(91.2±5.2)mmHg and(88.3±4.7)mmHg,respectively.The heart rate was(106.2±3.3)times/min and(101.9±4.0)times/min,respectively;compared with the control group at the same time point,the observation group had lower blood pressure and slower heart rate(t values were 4.25,2.53,6.40,6.81,1.85,and 1.35,all P<0.05).The blood concentrations of cardiac troponin and creatine kinase isoenzyme in the control group were(0.143±0.052)ng/ml and(5.65±0.77)mg/L at 12 h(T4)after surgery,which were higher than those in the observation group[(0.098±0.015)ng/ml and(3.08±1.06)mg/L](t values were 4.32 and 10.19,both P<0.05).The intraoperative utilization rate of vasoactive drugs and the incidence of electrocardiogram abnormalities in the observation group were 19.1%(9/47)and 25.5%(12/47),which were lower than those in the control group[48.9%(23/47)and 55.3%(26/47)](χ^(2)values were 8.49 and 8.66,both P<0.05).Compared with 1 day before operation(T5),the proportion of CD4+T cells increased and the proportion of CD8+T cells decreased in control group at 3 days after operation(T6)(both P<0.05).The pain score and sedation score of the observation group at 12 h(T4)and 1 day after surgery(T7)were better than those of the control group(all P<0.05).Conclusions Laparoscopic radical gastrectomy with intravenous combined epidural anesthesia in elderly gastric cancer patients with coronary heart disease can achieve better anesthesia effect,and can provide better protection for the patient's cardiac function and immune function.
作者
朱毅
武毅彬
赵丽
Zhu Yi;Wu Yibin;Zhao Li(Department of Anesthesiology,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China)
出处
《肿瘤研究与临床》
CAS
2022年第8期596-600,共5页
Cancer Research and Clinic
关键词
胃肿瘤
冠心病
腹腔镜
全凭静脉麻醉
静脉复合硬膜外麻醉
围手术期
心脏功能
免疫功能
Gastric neoplasms
Coronary artery disease
Laparoscope
Intravenous anesthesia
Intravenous combined epidural anesthesia
Perioperative period
Cardiac function
Immune function
