不同麻醉方法对下肢骨科手术老年患者术后肺部感染的影响研究

Influence of anesthesia approaches on postoperative pulmonary infections in elderly patients undergoing lower limb orthopedic surgery

目的探讨不同麻醉方法对下肢骨科手术老年患者术后肺部感染的影响,为其麻醉选择提供参考。方法将2016年5月-2017年3月医院治疗的110例下肢骨科手术老年患者随机分为对照组和试验组,各55例,对照组给予气管插管全身麻醉,试验组给予硬膜外麻醉,分别于术前、术后3d和7d比较两组患者的认知功能、咳嗽、发热、肺部啰音临床表现、白细胞总数、淋巴细胞百分率、中性粒细胞百分率及肺部感染率。结果术后3d和7d试验组患者的认知功能评分低于对照组,差异有统计学意义(P<0.05);试验组咳嗽、发热、肺部啰音发生率低于对照组,差异有统计学意义(P<0.05);试验组患者的白细胞总数和中性粒细胞百分率显著低于对照组,淋巴细胞百分率显著高于对照组,差异有统计学意义(P<0.05);试验组患者术后肺部感染率为5.45%显著低于对照组的20.00%,差异有统计学意义(P<0.05)。结论采用硬膜外麻醉方法对老年患者进行下肢骨科手术,可抑制炎症反应,降低术后肺部感染率。

OBJECTIVE To explore the influence of anesthesia approaches on postoperative pulmonary infections in elderly patients undergoing lower limb orthopedic surgery so as to provide guidance for selection of anesthesia ap-proach.METHODS A total of 110 elderly patients who underwent the lower limb orthopedic surgery in the hospital from May 2016 to Mar 2017 were enrolled in the study and randomly divided into the control group and the obser-vation group,with 55 cases in each group.The control group was treated with endotracheal intonation general an-esthesia,while the observation group was treated with epidural anesthesia.The cognitive function,cough,fever, clinical manifestations of lung rales,total white blood cells（WBC）counts,percentage of lymphocytes,percentage of neutrophils and incidence of pulmonary infection were observed and compared between the two groups of pa-tients before the surgery,and after the surgery for 3 and 7 days.RESULTS The cognitive function score of the ob-servation group was significantly lower than that of the control group after the surgery for 3 and 7 days（P〈0.05）.The incidence rates of cough,fever and pulmonary rales were significantly lower in the observation group than in the control group（P〈0.05）.The total WBC counts and percentage of neutrophils were significantly lower in the observation group than in the control group,the percentage of lymphocytes of the observation group was significantly higher than that of the control group（P〈0.05）.The incidence of postoperative pulmonary infections of the observation group was 5.45%,remarkably lower than 20.00% of the control group（P〈 0.05）. CONCLUSION The epidural anesthesia can inhibit the inflammatory reactions and reduce the incidence of postoper-ative pulmonary infections in the elderly patients undergoing the lower limb orthopedic surgery.