不同麻醉方式对骨科术后老年患者感染的影响研究

Effect of different anesthesia methods on postoperative infections of elderly patients in department of orthopedics

目的探讨不同麻醉方式对骨科术后老年患者感染的影响。方法选取2015年3月-2016年10月医院收治的老年骨科手术患者200例,根据麻醉方式的不同,分为A组66例,B组74例,C组60例,其中A组行气管插管全身麻醉,B组行硬膜外麻醉,C组行腰硬联合麻醉,回顾性分析三组患者术后恢复情况,并对三组术后感染部位分布情况、三组不同时间内血浆白细胞介素-6/白细胞介素-10(IL-6/IL-10)比值情况进行对比分析。结果 A组感染率为18.18%明显高于B组6.76%、C组5.00%,差异有统计学意义(P<0.05);所有患者麻醉前、手术结束时、术后24~48h,其IL-6/IL-10比值均呈逐渐递增的趋势增加,A组术后24~48h的IL-6/IL-10值(10.94±8.52)明显高于B组(7.88±4.52)、C组(7.04±3.57),差异有统计学意义(P<0.05)。结论气管插管全身麻醉不利于高龄患者使用,为了减少院内感染,提高手术治疗疗效,建议使用硬膜外麻醉或腰硬联合的麻醉方式。

OBJECTIVE To study and analyze the influences of different anesthesia methods on postoperative infection of elderly patients in department of orthopedics.METHODS A total of 200 elderly patients who received orthopedic surgery in our hospital from Mar.2015 to Oct.2016 were selected,and the patients were divided into three groups according to different anesthesia methods：group A（tracheal intubation general anesthesia,n=66）,group B（epidural anesthesia,n=74）,and group C（combined spinal-epidural anesthesia,n=60）.The postoperative recovery situations in the three groups were retrospectively analyzed,and the distribution of postoperative infection sites and the ratio of serum IL-6/IL-10 in different time points were comparatively analyzed.RESULTS The infection rate in group A（18.20%）was significantly higher than that in group B（6.75%）and group C（5.01%）.With the surgery performed,the IL-6/IL-10 ratio was increased gradually before anesthesia,at the end of operation and at 24~48 hafter operation.The IL-6/IL-10 ratio at 24-28 hours after surgery in group A（10.94±8.52）was significantly higher than that in group B（7.88 ±4.52）and group C（7.04±3.57）（P 0.05）.CONCLUSION Tracheal intubation general anesthesia is not suitable for elderly patients,so in order to reduce the infections during hospitalization and improve the surgery quality,epidural anesthesia or combined spinal-epidural anesthesia is recommended.