Li Jing, Fan Wanqiu, Peng Jian, Zeng Bencui, Wang Xinghao, Dong Biqian
Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
Department of Anesthesiology, People's Hospital of Yilong County, Nanchong, Sichuan, China.
Clin Hemorheol Microcirc. 2025 May;90(1):39-44. doi: 10.1177/13860291251335469. Epub 2025 May 13.
BackgroundLaparoscopic surgery is widely used in the field of clinical surgery due to its minimal trauma, minimal bleeding, short hospital stay, and fast postoperative recovery. There were several studies found that elderly patients undergoing laparoscopic surgery are more prone to coagulation disorders, increased blood viscosity, and the influence of CO pneumoperitoneum, which can easily lead to changes in blood rheology There are no studies have investigated the effects on blood rheology of general anesthesia combined with epidural block on hemorheology in elderly patients undergoing laparoscopic radical resection of rectal cancer. This trial investigated to explore the effect of general anesthesia combined with epidural block on blood rheology in elderly patients undergoing laparoscopic radical resection of rectal cancer, providing experimental basis for clinical anesthesia to regulate blood rheology characteristics and prevent hyperviscosity and its complications.MethodsA total of 60 patients undergoing laparoscopic radical resection of colorectal cancer aged 60-75 years, with American Society of Anesthesiologists physical status III, were enrolled in this study. All the subjects were randomly divided into general anesthesia group (group G, n = 30) and general anesthesia in combination with epidural block group (group G + E, n = 30) according to a random number table. Patients in the group G received the general anesthesia alone while those in the group G + E were given the combined epidural block based on anesthetic method of group G. The arterial blood gas indexes (pH, PaCO and HCO) and hemodynamic indexes(Hŋ, Lŋ,η, EAI, Hct and ESR) were measured at four time points: before induction of general anesthesia (T), 5 min before establishment of pneumoperitoneum (T), 30 min after establishment of pneumoperitoneum (T) and 30 min after elimination of pneumoperitoneum (T).ResultsThere was no significant statistical difference ( > 0.05) in pH, PaCO, and HCO between the two groups at T, T, and T. At T, there was no significant difference ( > 0.05) in Hŋ, Lŋ, η, Erythrocyte Aggregation Index (EAI), Hct, and Erythrocyte Sedimentation Rate (ESR) between the two groups. However, these indices were significantly lower in group G + E than in group G ( < 0.05) at T, T, and T.ConclusionCombining general anesthesia with epidural block can effectively reduce the hemorheological indexes of patients and improve the hemorheological state in elderly patients with malignant tumors undergoing laparoscopic surgery.
背景
腹腔镜手术因其创伤小、出血少、住院时间短及术后恢复快等优点，在临床外科领域得到广泛应用。多项研究发现，接受腹腔镜手术的老年患者更容易出现凝血功能障碍、血液黏稠度增加以及二氧化碳气腹的影响，这容易导致血液流变学发生改变。目前尚无研究探讨全身麻醉联合硬膜外阻滞对老年直肠癌患者腹腔镜根治性切除术中血液流变学的影响。本试验旨在探讨全身麻醉联合硬膜外阻滞对老年直肠癌患者腹腔镜根治性切除术中血液流变学的影响，为临床麻醉调控血液流变学特性、预防高黏血症及其并发症提供实验依据。
方法
本研究共纳入60例年龄在60 - 75岁、美国麻醉医师协会身体状况分级为Ⅲ级的行腹腔镜结直肠癌根治术患者。所有受试者根据随机数字表随机分为全身麻醉组（G组，n = 30）和全身麻醉联合硬膜外阻滞组（G + E组，n = 30）。G组患者仅接受全身麻醉，G + E组患者在G组麻醉方法的基础上联合硬膜外阻滞。于全身麻醉诱导前（T₁）、气腹建立前5分钟（T₂）、气腹建立后30分钟（T₃）和气腹解除后30分钟（T₄）四个时间点测量动脉血气指标（pH、PaCO₂和HCO₃⁻）及血流动力学指标（高切黏度（Hŋ）、低切黏度（Lŋ）、全血黏度（η）、红细胞聚集指数（EAI）、血细胞比容（Hct）和红细胞沉降率（ESR））。
结果
两组在T₁、T₂和T₃时pH、PaCO₂和HCO₃⁻差异无统计学意义（P > 0.05）。在T₄时，两组高切黏度（Hŋ）、低切黏度（Lŋ）、全血黏度（η）、红细胞聚集指数（EAI）、血细胞比容（Hct）和红细胞沉降率（ESR）差异无统计学意义（P > 0.05）。然而，在T₂、T₃和T₄时，G + E组这些指标显著低于G组（P < 0.05）。
结论
全身麻醉联合硬膜外阻滞可有效降低患者血液流变学指标，改善老年恶性肿瘤患者腹腔镜手术中的血液流变学状态。
