不同麻醉方法对老年结直肠癌手术患者白细胞糖代谢的影响

目的 评价不同麻醉方法对老年结直肠癌患者白细胞糖代谢的影响.方法择期拟行结直肠癌手术患者50例,年龄≥65岁,体重指数18～25 kg/m3,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为七氟醚吸入全麻组(Sevo组)和七氟醚吸入全麻联合硬膜外阻滞组(S+E组),每组25例.S+E组入室后硬膜外穿刺置管,给予2%利多卡因3 ml,5 min后确认无腰麻征象,给予1%利多卡因和0.2%丁卡因混合液8～10ml,每隔50min追加4～5ml.术中患者呼气末七氟醚浓度S+E组维持0.7 MAC,Sevo组维持1.0 MAC,根据BIS值监测调整麻醉深度.分别于麻醉前10 min(T1)、手术结束后60 min(T2)、24 h(T3)和5 d(T4)时采集外周静脉血,计数白细胞,检测白细胞内丙酮酸激酶(PK)和葡萄糖6-磷酸脱氢酶(C6PD)的活性.结果 与T1时比较,两组T3时白细胞计数均升高,S+E组T3时白细胞内PK活性、Sevo组T3时、S+E组T3,4时白细胞内G6PD活性升高(P＜0.01);与Sevo组比较,S+E组T3时白细胞内PK活性、T3,4时白细胞内G6PD活性升高(P＜0.05),白细胞计数差异无统计学意义(P＞0.05).结论 两种麻醉方法用于老年结直肠癌手术患者时白细胞计数无明显差别,但七氟醚吸入全麻联合硬膜外阻滞较单纯吸人七氟醚全麻时老年患者白细胞功能增强.

Abstract：

Objective To evaluate the influence of different methods of anesthesia on the glucose metabolism of leukocytes in elderly patients undergoing colorectal cancer surgery. Methods Fifty ASA Ⅰ or Ⅱ patients, aged≥65 yr, with body mass index 18-25 kg/m2, scheduled for elective colorectal cancer surgery, were randomly divided into 2 groups ( n = 25 each) : sevoflurane anesthesia group (Sevo group) and sevoflurane anesthesia combined with epidural block group ( S + E group) . The patients in S + E group underwent epidural catheterization, and 2% lidocaine 3 ml was given via the epidural catheter. If no signs of spinal anesthesia were confirmed 5 min later, the mixture of 1% lidocaine and 0.2% tetracaine 8-10 ml was given, and an increment of the mixture 4-5 ml was given every 50 min. During the operation, the end-tidal concentration of sevoflurane was maintained at 0.7 MAC in S + E group and at 1.0 MAC in Sevo group. The depth of anesthesia was adjusted according to the BIS value in both groups. Venous blood samples were taken at 10 min before operation (T1 ), and 60 min, 24 h.and 5 days after the end of operation (T2-4 ) for WBC count and measurement of activities of pyruvate kinase (PK)and glucose-6-phosphate dehydrogenase (G6PD) in the leukocytes. Results Compared with T1, the WBC count at T3 in both groups, the PK activity at T, in group S+E and G6PD activity at T, in group Sevo and at T3,4 in group S + E were significantly increased ( P ＜ 0.01) . Compared with group Sevo, the PK activity at T, and G6PD activity at T3,4 were significantly increased in group S+E ( P ＜ 0.05) . There was no significant difference in the WBC count between the two groups ( P ＞ 0.05) . Conclusion There is no significant change in the WBC count when the two methods of anesthesia are used in elderly patients undergoing colorectal caner surgery, however, sevoflurane anesthesia combined with epidural block enhances the leukocyte function in elderly patients compared with sevoflurane anesthesia alone.

Influence of different methods of anesthesia on glucose metabolism of leukocytes in elderly patients undergoing colorectal cancer surgery

Objective To evaluate the influence of different methods of anesthesia on the glucose metabolism of leukocytes in elderly patients undergoing colorectal cancer surgery. Methods Fifty ASA Ⅰ or Ⅱ patients, aged≥65 yr, with body mass index 18-25 kg/m2, scheduled for elective colorectal cancer surgery, were randomly divided into 2 groups ( n = 25 each) : sevoflurane anesthesia group (Sevo group) and sevoflurane anesthesia combined with epidural block group ( S + E group) . The patients in S + E group underwent epidural catheterization, and 2% lidocaine 3 ml was given via the epidural catheter. If no signs of spinal anesthesia were confirmed 5 min later, the mixture of 1% lidocaine and 0.2% tetracaine 8-10 ml was given, and an increment of the mixture 4-5 ml was given every 50 min. During the operation, the end-tidal concentration of sevoflurane was maintained at 0.7 MAC in S + E group and at 1.0 MAC in Sevo group. The depth of anesthesia was adjusted according to the BIS value in both groups. Venous blood samples were taken at 10 min before operation (T1 ), and 60 min, 24 h.and 5 days after the end of operation (T2-4 ) for WBC count and measurement of activities of pyruvate kinase (PK)and glucose-6-phosphate dehydrogenase (G6PD) in the leukocytes. Results Compared with T1, the WBC count at T3 in both groups, the PK activity at T, in group S+E and G6PD activity at T, in group Sevo and at T3,4 in group S + E were significantly increased ( P ＜ 0.01) . Compared with group Sevo, the PK activity at T, and G6PD activity at T3,4 were significantly increased in group S+E ( P ＜ 0.05) . There was no significant difference in the WBC count between the two groups ( P ＞ 0.05) . Conclusion There is no significant change in the WBC count when the two methods of anesthesia are used in elderly patients undergoing colorectal caner surgery, however, sevoflurane anesthesia combined with epidural block enhances the leukocyte function in elderly patients compared with sevoflurane anesthesia alone.