不同麻醉方式对上腹部手术老年患者肺功能指标与炎症因子及T淋巴细胞亚群的影响

Effects of different anesthesia methods on pulmonary infection,inflammatory cytokines and T lymphocyte subsets in elderly patients with upper abdominal surgery

目的探讨行上腹部手术的老年患者在接受不同麻醉方式后,对其肺部感染、炎症因子以及T淋巴细胞亚群的影响。方法选取2015年1月-2016年11月于医院行上腹部手术的老年患者100例为研究对象,按照不同的麻醉方式分为全凭静脉全身麻醉组(A组)32例、硬膜外阻滞复合静脉麻醉组(B组)33例、吸入麻醉组(C组)35例,对比患者麻醉前后的呼吸功能相关指标、恢复自主呼吸时间、睁眼及拔管时间,同时比较患者在术后肺部感染症状和感染发生率、以及在术后6、24、72h的炎症因子(IL-1β、IL-4、IL-6、IL-8)和T淋巴细胞亚群(CD_3^+、CD_4^+、CD_8^+)的水平变化。结果 B组患者呼吸功能的各项指标、恢复自主呼吸时间、自主睁眼时间和拔管时间均比A、C两组优越(P均<0.05);B组患者的肺部感染症状发生情况和感染率均低于A组和C组(P均<0.05);术后6、24、72h检测三组的IL-1β、IL-4、IL-6、IL-8和CD_3^+、CD_4^+、CD_8^+浓度水平存在明显差异(P均<0.05)。结论老年患者行上腹部手术采取全身麻醉复合神经阻滞的麻醉方式,有利于患者尽早恢复呼吸、降低术后肺感染的发生率,患者的炎症反应较轻,对T淋巴细胞亚群浓度能够有效维持平衡,是老年患者上腹部手术比较理想的麻醉方式。

OBJECTIVE To investigate the effects of different anesthesia methods on the pulmonary infection,inflammatory cytokines and T lymphocyte subsets in elderly patients with upper abdominal surgery.METHODS A total of 100 elderly patients who underwent upper abdominal surgery in our hospital from Jan.2015 to Nov.2016 were chosen in this study.According to different anesthesia methods,they were divided into the total intravenous general anesthesia group（group A）of 32 cases,the epidural anesthesia combined with intravenous anesthesia group（group B）of 33 cases,and the inhalation anesthesia group（group C）of 35 cases.The respiratory function indexes,recovery time of spontaneous breathing,open-eye and extubation time were compared in patients before and after anesthesia.At the same time,the occurrence of pulmonary infection symptoms and infection rates,the changes of the levels of inflammatory cytokines（IL-1β,IL-4,IL-6 and IL-8）and T cell subsets（CD3^＋,CD4^＋ and CD8^＋）at 6 h,24 h and 72 h after surgery were compared.RESULTS The respiratory function indexes,recovery time of spontaneous breathing,open-eye time and extubation time in group B were better than those in group A and C（P〈0.05）.The occurrence of pulmonary infection symptoms and infection rate of pulmonary infection in group B were lower than those in group A and C（P〈0.05）.There were significant differences of the detected IL-1 β,IL-4,IL-6,IL-8 and CD3^＋,CD4^＋,CD8^＋ concentration levels of the three groups at 6 h,24 h,72 h after surgery（all P〈0.05）.CONCLUSION The anesthesia of general anesthesia combined with nerve block in elderly patients with upper abdominal surgery is beneficial to the early recovery of respiration and can reduce the incidence of postoperative pulmonary infection.The inflammatory reaction of the patients is less severe and it can effectively maintain balance for the concentrations of T lymphocyte subsets,which is the ideal anesthesia way for elderly patients with upper abdominal surgery.