不同麻醉方式对老年患者上腹部手术肺部感染的影响

Influence of Different Anesthesia Methods on postoperative Pulmonary Infection in Elderly Patients Undergoing Upper Abdominal Surgery

目的:观察临床应用不同的麻醉方式对老年上腹部手术患者肺部感染的影响。方法:选取2014年4月至2016年4月进行上腹部手术102例患者,按随机数字表法随机分为A、B、C三组各34例,分别给予硬膜外阻滞复合全身麻醉、吸入、全凭静脉全身麻醉三种麻醉方式,观察三组患者术后肺部感染发生情况。结果:术后B、C两组的拔管、苏醒时间及肺部感染发生率比较无明显差异(P>0.05),均明显高于A组(P<0.05),术后6h三组患者的IL-6、IL-8水平较术前明显升高(P<0.05),CD4+/CD8+比值则较术前明显降低(P<0.05),术后3d,A组恢复到术前水平,而B、C两组仍与A组有明显差距(P<0.05)。结论:硬膜外阻滞复合全身麻醉对患者术后意识恢复及降低肺部感染的发生有积极作用。

Objective ： To observe the effects of different anesthetic methods on postoperative pulmonary infections in the elderly patients with upper abdominal surgery. Methods： A total of 102 cases of elderly pa- tients with upper abdominal surgery from April 2014 to April 2016 were enrolled. They were randomly divided into epidural block combined with general anesthesia （group A）, inhalation anesthesia group （group B） and total intravenous anesthesia group （group C） with 34 cases each. The extubation time, recovery time, inci- dence of postoperative pulmonary infections were observed and compared among the three groups. Results： The extubnation time, recovery time and incidence of postoperative pulmonary infection in group A were significantly better than those in both group B and group C （ p〈0.05 ） , but there was no significant difference in those between group B and group C （p〉0.05）. The level of interleukin-6（IL-6） and interleukin-8（IL-8） were increased apparently in the 6h after the surgery of the three groups （ p〈0.05 ） , but T lymphocyte subsets CD4＋/CD8＋ ratio reduced apparently （p〈0.05） compared with those before anesthesia. 3d after the operation, the level of IL-6, IL-8 and CD4＋/CD8＋ ratio in group A restored to preoperative level while those in group B and C did not（p〈0.05）. Conclusion： Epidural block combined with general anesthesia has a positive effect on postoperative recovery of consciousness and reduces the incidence of （ postoperative ） pulmonary infection.