不同麻醉方式对老年下肢骨折患者术后肺部感染发生率的影响

Effects of different anesthesia methods on incidence of postoperative pulmonary infections in elderly patients with lower extremity fracture

目的研究不同麻醉方式对老年下肢骨折患者术后肺部感染的影响,以期为临床老年下肢骨折患者选择最佳麻醉方式提供参考。方法选取2012年1月-2015年1月间行下肢骨折手术的老年患者264例,根据术前会诊、患者及家属意愿选定的麻醉方案实施麻醉术。其中气管插管全身麻醉74例(A组),硬膜外麻醉122例(B组),68例行腰硬联合麻醉(C组);观察三组患者手术一般情况及呼吸功能相关指标及术后肺部感染的发生情况。结果三组患者在出血量、手术时间、疼痛评分与住院时间,差异无统计学意义。麻醉前,三组患者血氧饱和度(SpO_2)、呼吸速率(RR)、分钟通气量(MV)无显著差异,手术结束后A组与B组呼吸功能相关指标无显著差异,但C组与A组与B组相比,差异显著(P<0.05)。A组术后肺部感染率8.11%,B组则为4.92%,C组则为2.94%。C组感染率显著低于A组与B组(P<0.05)。结论老年下肢骨折患者选择腰硬联合阻滞麻醉,有助于患者术后改善呼吸功能并显著降低术后肺部感染的发生率。

OBJECTIVE To investigate the effect of different anesthesia methods on postoperative pulmonary infection in elderly patients with lower extremity fracture,so as to provide references for the selection of the best anesthesia method for elderly patients with lower extremity fracture.METHODS A total of 264 elderly patients with lower extremity fracture surgery from Jan.2012 to Jan.2015 were selected.Anesthesia methods were selected according to the preoperative consultation and willingness of patients and their families.Among them,74cases（group A）were given general anesthesia by tracheal intubation,122cases（group B）were given epidural anesthesia,68cases（group C）were treated with combined spinal epidural anesthesia.The general situation of the operation,the related indexes of respiratory function and the incidence of postoperative pulmonary infection in the three groups were observed.RESULTS There was no significant difference between the three groups in the amount of bleeding,operation time,pain score and hospitalization time.Before anesthesia,there was no significant difference in pulse oxygen saturation（SpO_2）,respiration rate（RR）and minute ventilation volume（MV）among the three groups.After operation,there was no significant difference in the related indexes of respiratory function between group A and group B,but the difference between group C group and group A and B was significant（P〈0.05）.The postoperative pulmonary infection rate in group A was 8.11%,in group B group was 4.92%,and in group C was 2.94%.The infection rate of group C was significantly lower than that of group A and group B（P〈0.05）.CONCLUSIONCombined spinal epidural anesthesia in elderly patients with lower extremity fracture is helpful to improve respiratory function and reduce the incidence of postoperative pulmonary infections.