不同麻醉方式对老年择期手术患者术后肺部感染的影响分析

Effects of different anesthesia methods on postoperative pulmonary infections in elderly patients undergoing elective surgery

目的分析老年择期手术患者采用不同麻醉方式对其术后肺部感染的影响,为临床治疗提供参考依据。方法选取2013年2月-2014年1月医院外科收治的76例老年择期手术患者,按照手术麻醉方式的不同分为观察组患者46例和对照组患者30例,观察组行全麻复合硬膜外阻滞麻醉,对照组行静吸复合全麻,分析对比两组患者术后恢复及术后肺部感染率等,数据采用SPSS 14.0软件进行统计分析。结果观察组患者拔管时间、苏醒时间明显优于对照组,差异有统计学意义(P<0.05);麻醉前1h两组患者的CD3+、CD4+、CD8+、CD4+/CD8+的差异均无统计学意义;两组患者术后2、12、24、72h后CD3+、CD4+、CD8+、CD4+/CD8+的水平与麻醉之前相比有所降低,差异有统计学意义(P<0.05);在行手术后3d内,观察组发生肺部感染率明显低于对照组,差异有统计学意义(P<0.05)。结论对于择期手术行全麻复合硬膜外阻滞的老年患者容易清醒,并且对患者本身的免疫功能影响小,术后肺部感染率较低。

OBJECTIVE To observe the effects of different anesthesia methods on postoperative pulmonary infec- tions in the elderly patients undergoing elective surgery so as to provide guidance for clinical treatment. METHODS A total of 76 elderly patients who underwent the elective surgery in the surgery department from Feb 2013 to Jan 2014 were enrolled in the study and divided into the observation group with 46 cases and the control group with 30 cases according to the anesthesia mode. The observation group was treated with general anesthesia combined with epidural blockade anesthesia, while the control group was given the intravenous anesthesia combined with inhala- tion anesthesia. The postoperative recovery and the incidence of postoperative pulmonary infections were observed and compared between the two groups of patients, and the statistical analysis of data was performed with the use of SPSS 14.0 software. RESULTS The extubation time and the recovery time of the observation group were signif- icantly shorter than those of the control group （P〈0. 05）. There was no significant difference in the level of CD3 ＋ , CD4 ＋ , CD8 ＋ , or CD4 ＋/CD8 ＋ between the two grouPs of patients at one hour before the anesthesia. The levels of CD3 ＋ , CD4 ＋ , CD8 ＋ , and CD4 ＋/CD8 ＋ of both groups were sigificeatly lower at 2, 12, 24, and 72 hours after the surgery than before the anesthesia （P〈0.05）. Within three days after the surgery, the incidence of post- operative pulmonary infections of the observation group was significantly lower than that of the control group （P〈0.05）. CONCLUSION The elderly patients who undergo the elective surgery under tKe general anesthesia com- bined with epidural blockade anesthesia are prone to recover, this anesthesia method has little impact on the immune function, with the incidence of postoperative pulmonary infections low.