不同麻醉方式对老年腹部手术患者术后肺部感染影响的分析

Influence of different anesthesia methods on postoperative pulmonary infections in elderly patients undergoing abdominal surgery

目的探讨不同麻醉方式对老年患者开腹手术围麻醉期及术后肺部感染的影响,为临床选择合理的麻醉方式提供参考。方法选取2012年1月-2013年12月老年开腹手术患者133例,其中A组57例,采用全身麻醉(静脉麻醉),B组41例,采用全身麻醉(吸入麻醉),C组35例,采用腰硬联合麻醉,观察3组患者心率(HR)、血流动力学平均动脉压值(MAP)、苏醒时间、拔管时间、术后短期认知功能及术后肺部感染等。结果静脉麻醉与吸入麻醉手术10min、术后HR、MAP差异有统计学意义(P<0.05),腰硬联合麻醉组苏醒时间、拔管时间、麻醉后认知障碍等方面显著优于全身麻醉两组(P<0.05),C组的肺部感染率5.71%,显著低于A组的21.95%、B组的19.30%,差异有统计学意义(P<0.05),静脉麻醉与吸入麻醉两组观察的各项指标差异无统计学意义,腰硬联合麻醉组术中有明显烦躁、恶心、呕吐、疼痛等牵拉反应。结论腰硬联合麻醉后比全身麻醉认知障碍、肺部感染率低,但麻醉效果劣于全身麻醉,术中有明显的牵拉反应。

OBJECTIVE To explore the effects of different anesthesia methods on postoperative pulmonary infections in the elderly patients undergoing abdominal surgery so as to choose the appropriate anesthesia method.METHODS A total of 133 elderly patients who underwent the abdominal surgery from Jan 2012 to Dec 2013 were enrolled in the study.The group A with 57 cases was treated with genera anesthesia（intravenous anesthesia）,the group B with 41 cases was treated with general anesthesia（inhalation anesthesia）,and the group C with 35 cases was treated with combined spinal-epidural anesthesia.The heart rate（HR）,haemodynamic mean arterial pressure（MAP）,recovery time,extubation time,short-term cognitive function,and incidence of postoperative pulmonary infections were observed and compared among the three groups.RESULTS There was significant difference in the HR or MAP between the intravenous anesthesia and the inhalation anesthesia at 10 min after the surgery（P〈0.05）.The recovery time,extubation time,and cognitive impairment of the combined spinal-epidural anesthesia group were significantly better than those of the two general anesthesia groups（P〈0.05）.The incidence of pulmonary infections was 5.71%in the group C,significantly lower than 21.95%in the group A and 19.30%in the group B（P〈0.05）.There was no significant difference in any of the observation indicators between the intravenous anesthesia group and the inhalation anesthesia group.The patients in the combined spinal-epidural anesthesia group had remarkable intraoperative traction reactions such as irritability,nausea,vomiting,and pain.CONCLUSIONThe combined spinal-epidural anesthesia may induce lower incidence of cognitive impairment and pulmonary infections than the general anesthesia,however,the anesthesia effect of the combined spinal-epidural anesthesia is not as good as that of the general anesthesia,the remarkable intraoperative traction reactions occur during the surgery.