全麻复合硬膜外麻醉在高龄低位直肠癌患者术中的应用效果

目的:研究全麻复合硬膜外麻醉在高龄低位直肠癌患者术中的应用效果。方法:选取我院68例高龄低位直肠癌患者，按照随机数字表法分组，各34例。两组均行腹腔镜手术，对照组采取全麻，观察组采取全麻复合硬膜外麻醉。比较两组麻醉前（T0）、气管插管后即刻（T1）、气腹后0.5 h（T2）、拔管后5 min（T3）血压［收缩压（SBP）、舒张压（DBP）］、心率（HR）、应激反应血清因子［皮质醇（Cor）、白细胞介素-4（IL-4）、IL-8］水平、术后苏醒质量及不良反应发生情况。结果:观察组T0-T3时期SBP、DBP、HR波动幅度较对照组小（P<0.05）；两组T0-T2时期Cor、IL-4、IL-8水平呈上升趋势，T2-T3时期呈下降趋势，观察组波动幅度较对照组小（P<0.05）；观察组顺苯磺酸阿曲库铵、舒芬太尼用量较对照组低（P<0.05）；观察组自主呼吸恢复时间、拔管时间、完全清醒时间较对照组短（P<0.05）；两组躁动、室性早搏发生率无明显差异（P>0.05）；观察组恶心呕吐发生率5.88%较对照组23.53%低（P<0.05）。结论:全麻复合硬膜外麻醉应用于高龄低位直肠癌患者术中，可有效维持术中血压、心率稳定，减少全麻药物使用剂量，减轻术中应激反应，提高苏醒质量，还可降低恶心呕吐等不良反应发生率。

Application effect of general anesthesia combined with epidural anesthesia in elderly patients with low rectal cancer

Objective:To study the application effect of general anesthesia combined with epidural anesthesia in elderly patients with low rectal cancer.Methods:A total of 68 elderly patients with low rectal cancer were enrolled in our hospital.All patients were divided into 34 patients according to the random number table method.Laparoscopic surgery was performed in both groups.General anesthesia was used in the control group，and general anesthesia combined with epidural anesthesia was performed in the observation group.Compare the blood pressure before the two groups(T0)，immediately after tracheal intubation(T1)，at 0.5 h after pneumoperitoneum(T2)，and 5 min after extubation(T3) blood pressure［systolic blood pressure(SBP)，diastolic blood pressure(DBP)］，heart rate(HR)，stress response serum factors［cortisol(Cor)，interleukin-4(IL-4)，IL-8］ levels，postoperative recovery quality and adverse reactions.Results:The fluctuation range of SBP，DBP and HR in the observation group from T0 to T3 was smaller than that in the control group(P<0.05).In the two groups.Cor，TL-4，IL-8 levels were increased form T0 to T2，and reduced form T2 to T3.The fluctuation of observation group was smaller than control group(P<0.05).The dosage of atracurium and fentanyl sulfonate was lower in the observation group than in the control group(P<0.05).The time of spontaneous breathing recovery，extubation time and complete waking time in the observation group were shorter than those in the control group(P<0.05).There was no significant difference in the incidence of turbulence and premature ventricular contractions between the two groups(P>0.05).The incidence of nausea and vomiting in the observation group was 5.88% lower than that in the control group(23.53%)(P<0.05).Conclusion:General anesthesia combined with epidural anesthesia is effective in the treatment of elderly patients with low rectal cancer.Can effectively maintain intraoperative blood pressure，stable heart rate，reduce the dose of general anesthetic drugs，reduce intraoperative stress response，improve the quality of recovery，and reduce the incidence of adverse reactions such as nausea and vomiting.