不同麻醉方式对胃癌患者术后下呼吸道感染的影响研究

Effects of different anesthesia methods on postoperative lower respiratory tract infections in patients with gastric cancer

目的研究不同的麻醉方式对胃癌患者术后发生下呼吸道感染的影响因素及感染病原菌种类,为预防与控制患者术后发生下呼吸道感染制定针对性措施提供参考依据。方法选取择期行胃癌手术的患者82例,随机均分为A组和B组,各41例,A组患者硬膜外阻滞复合全身麻醉气管内插管+术后硬膜外自控镇痛(PCEA);B组患者全身麻醉气管内插管+术后静脉自控镇痛(PCIA),感染病原菌分离培养、菌种鉴定和药敏试验严格依据《全国临床检验操作规程》中临床微生物学检验章节中的常规方法进行。结果下呼吸道感染率A组为4.9%、B组为19.5%;A组患者术后恢复自主呼吸时间和拔管时间均明显少于B组,两组比较差异有统计学意义(P<0.05);A组患者术后3d的发热、咳嗽、咳痰、肺部啰音、血白细胞总数>15×109/L、胸部X线检查炎症表现均显著低于B组(P<0.05);感染病原菌主要是铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌、金黄色葡萄球菌等多药耐药菌。结论采用硬膜外阻滞复合全身麻醉气管内插管加术后PCEA的麻醉方式,可有效减少胃癌患者术后下呼吸道感染的发生,以缩短患者住院时间,提高临床治愈率。

OBJECTIVE To explore the influencing factors for different anesthesia methods‐induced postoperative lower respiratory tract infections in the patients with gastric cancer and analyze the species of pathogens causing infection so as to put forward targeted measures for the prevention and control of the postoperative respiratory tract infections .METHODS Totally 82 patients who underwent the elective gastric cancer surgery were recruited in the study and randomly divided into the group A and the group B ,with 41 cases in each group ;the group A was treated with epidural blockade combined with general anesthesia endotracheal intubation plus postoperative controlled epidural analgesia （PCEA）;the group A was given the general anesthesia endotracheal intubation plus postoperative controlled intravenous analgesia （ PCIA ）; the isolation , culture , identification , and drug susceptibility testing of the pathogens causing infections were performed by referring to the conventional methods in the chapters of clinical microorganisms examination of the National Guide to Clinical Laboratory Operation Procedures .RESULTS The incidence of lower respiratory tract infections was 4 .9% in the group A ,19 .5% in the group B ,19 .5% in the group B ;the time of recovery of postoperative spontaneous breath and the extubation time of the group A were significantly shorter than those of the group B , and there were statistically significant differences between the two groups （P〈 0 .05） .The ratios of the postoperative 3 days fever ,cough ,sputum , pulmonary rales ,blood leukocytes more than 15 × 109/L ,and chest X‐ray showing inflammation of the group A were significantly lower than those of the group B （P〈0 .05） .The multidrug‐resistant Pseudomonas aeruginosa , Klebsiella pneumoniae ,Acinetobacter baumannii ,and Staphylococcus aureus were the predominant species of pathogens causing infections .CONCLUSIONS The epidural blockade combined with general anesthesia endotracheal intubation plus PCEA can contribute to the reduction of incidence of postoperative lower respiratory tract infections ,shorten the length of hospital stay ,and improve the cure rate .