硬膜外麻醉复合气管插管全身麻醉对老年低位直肠癌患者机体氧化应激反应的影响

目的分析硬膜外麻醉复合气管插管全身麻醉对老年低位直肠癌患者机体氧化应激反应的影响。方法选取2016年1月～2019年1月我院收治的62例老年低位直肠癌手术患者,将其简单随机化分为两组,对照组(n=31)接受气管插管全身麻醉,观察组(n=31)接受硬膜外麻醉复合气管插管全身麻醉,比较两组麻醉诱导前(T_1)、诱导后(T_2)、气管插管即刻(T_3)、切皮时(T_4)、拔管时(T5)心率(HR)、平均动脉压(MAP)变化、肾上腺素(AE)、去肾上腺素(NE)、超氧化物歧化酶(SOD)、皮质醇(Cor)、丙二醛(MDA)水平、拔管时间、睁眼时间、维库溴铵应用剂量、不良反应发生率。结果观察组T_2、T_3、T_4、T_5时刻MAP、HR波动小于对照组,AE、NE、Cor、MDA低于对照组,SOD高于对照组(P0.05);观察组拔管时间、睁眼时间短于对照组,维库溴铵应用剂量低于对照组(P0.05);观察组不良反应发生率低于对照组19.35%(6/31)(P0.05)。结论硬膜外麻醉复合气管插管全身麻醉应用于老年低位直肠癌,可阻断手术刺激传导至中枢,并抑制外源性刺激上行传导及下丘脑-垂体-肾上腺髓质轴的兴奋,能减少血流动力学波动,减轻机体氧化应激反应,减少肌松药物应用剂量,加快患者恢复,安全可靠。

Effect of epidural anesthesia combined with tracheal intubation general anesthesia on oxidative stress in elderly patients with low rectal cancer

Objective To analyze the effect of epidural anesthesia combined with tracheal intubation general anesthesia on oxidative stress in elderly patients with low rectal cancer.Methods 62 elderly patients with low rectal cancer admitted in our hospital from January 2016 to January 2019 were enrolled in this study.The patients were randomized into groups.The control group(n=31)underwent tracheal intubation general anesthesia.The observation group(n=31)was treated with epidural anesthesia combined with tracheal intubation general anesthesia.The heart rate(HR),mean arterial pressure(MAP)changes,adrenaline(AE),norepinephrine(NE),superoxide dismutase(SOD),cortisol(Cor),malondialdehyde(MDA)level,extubation time,blink time,vecuronium application dose and incidence of adverse reactions were compared between the two groups before(T1)and after induction(T2)of anesthesia,at time of endotracheal intubation(T3),skin incision(T4),and extubation(T5).Results The MAP and HR fluctuations in the observation group were lower than those in the control group at T2,T3,T4and T5.The AE,NE,Cor and MDA in the observation group were lower than those of the control group,and the SOD in the observation group was higher than that of the control group(P<0.05).The extubation time and blink time of the observation group was shorter than that of the control group,and the dose of vecuronium of the observation group was lower than that of the control group(P<0.05).The incidence of adverse reactions in the observation group was lower than 19.35%(6/31)of the control group(P<0.05).Conclusion Epidural anesthesia combined with tracheal intubation general anesthesia in elderly patients with low rectal cancer can block the conduction of surgery stimulation to the central nervous system,and inhibit the upward conduction of exogenous stimulation and the excitation of hypothalamic-pituitary-adrenal medullary axis.It can also reduce hemodynamic fluctuations,reduce the body''s oxidative stress response,reduce the dose of muscle relaxant drugs,accelerate patient recovery,with safety and reliability.