硬膜外麻醉联合全麻在老年结直肠癌患者腹腔镜手术中的应用价值

目的　探讨硬膜外麻醉联合全身麻醉（全麻）在老年结直肠癌患者腹腔镜手术中的应用价值。方法　采用回顾性研究，选取南阳医学高等专科学校第一附属医院2020年6月至2021年12月接受腹腔镜手术治疗的133例老年结直肠癌患者临床资料展开分析，分析其病例资料后根据麻醉方案不同将患者分为对照组（66例）与研究组（67例）。对照组男35例、女31例，年龄（64.58±4.59）岁，采用常规全麻；研究组男37例、女30例，年龄（64.65±4.73）岁，接受全麻联合硬膜外麻醉。对比两组一氧化氮（NO）、匹兹堡睡眠质量指数（PSQI）、肾上腺皮质激素（ACTH）、血清胃动素（MTL）、简易精神状态评价量表（MMSE）、生长抑素（SS）、D-乳酸（D-LA）以及不良反应发生率。计量资料采用t检验，计数资料采用χ²检验，等级资料采用秩和检验。结果　术前1 d，两组老年结直肠癌患者NO、ACTH、MTL、SS、D-LA水平及MMSE、PSQI评分比较，差异均无统计学意义（均P>0.05）。术后3 d，研究组NO、ACTH水平分别为（296.32±43.85）μmol/ml、（35.25±8.36）pg/ml，均低于对照组（353.57±58.36）μmol/ml、（43.54±7.69）pg/ml，差异均有统计学意义（均P<0.05）。术后7 d，研究组D-LA水平为（115.75±21.13）μg/L，低于对照组（138.75±19.26）μg/L，MTL、SS水平分别为（237.91±51.06）pg/ml、（556.17±23.26）pg/ml，均高于对照组（215.45±40.95）pg/ml、（544.28±20.14）pg/ml，差异均有统计学意义（均P<0.05）。术后3 d，研究组MMSE评分为（25.43±2.41）分，高于对照组（21.69±2.23）分，PSQI评分为（5.59±1.15）分，低于对照组（7.46±1.62）分，差异均有统计学意义（均P<0.05）。研究组不良反应发生率为2.98%（2/67），明显低于对照组15.15%（10/66），差异有统计学意义（χ²=5.995，P=0.014）。结论　硬膜外麻醉联合全麻在老年结直肠癌患者腹腔镜手术中应用效果确切良好，有助于减轻患者手术应激反应，促进患者术后胃肠及认知功能的恢复。

Clinical value of epidural anesthesia combined with general anesthesiain laparoscopic surgery for elderly patients with colorectal cancer

Objective　To explore the value of epidural anesthesia combined with generalanesthesia in laparoscopic surgery for elderly patients with colorectal cancer. Methods　A retrospective study was conducted on theclinical data of 133 elderly patients with colorectal cancer who underwentlaparoscopic surgery in The First Affiliated Hospital of Nanyang MedicalCollege from June 2020 to December 2021. After analyzing the medical records,the patients were divided into a control group (66 cases) and a study group (67cases) according to different anesthesia schemes. There were 37 males and 30females in the study group, aged (64.65±4.73) years; in the control group,there were 35 males and 31 females, aged (64.58±4.59) years. The control groupreceived routine general anesthesia, and the study group received generalanesthesia combined with epidural anesthesia. Nitric oxide (NO), PittsburghSleep Quality Index (PSQI), adrenocortical hormone (ACTH), serum motilin (MTL),Mini Mental State Examination (MMSE), somatostatin (SS), D-lactic acid (D-LA),and the incidence of adverse reactions were compared between the two groups. t test was used for the measurementdata, χ² test was used forthe count data, and rank sum test was used for the grade data. Results　The levels of NO, ACTH, MTL, SS, and D-LA andscores of MMSE and PSQI in the two groups showed no significant differences 1day before surgery (all P>0.05).Three days after surgery, the levels of NO and ACTH in the study group were(296.32±43.85) μmol/ml and (35.25±8.36) pg/ml, respectively, which were lowerthan those in the control group [(353.57±58.36) μmol/ml and (43.54±7.69)pg/ml], with statistically significant differences (both P<0.05). Seven days after surgery, the level of D-LA of thestudy group was (115.75±21.13) μg/L, which was lower than that of the controlgroup [(138.75±19.26) μg/L], the levels of MTL and SS were (237.91±51.06) pg/mland (556.17±23.26) pg/ml, respectively, which were higher than those in thecontrol group [(215.45±40.95) pg/ml and (544.28±20.14) pg/ml], withstatistically significant differences (all P<0.05).Three days after surgery, the MMSE score of the study group was (25.43±2.41),which was higher than that of the control group [(21.69±3.23)], and the PSQIscore was (5.59±1.15), which was lower than that of the control group[(7.46±1.62)], with statistically significant differences (both P<0.05). The incidence of adversereactions in the study group was 2.98% (2/67), which was significantly lowerthan that in the control group [15.15% (10/66)] (χ²=5.995, P=0.014). Conclusion　Epidural anesthesiacombined with general anesthesia is effective in laparoscopic surgery forelderly patients with colorectal cancer, which is helpful to reduce theirsurgical stress response and promote the recovery of gastrointestinal andcognitive functions after surgery.