气管插管全身麻醉联合硬膜外麻醉对腹部手术患者术后感染的研究

Effects of tracheal intubation general anesthesia and epidural anesthesia on postoperative infections in patients with abdominal surgery

目的探讨气管插管全身麻醉与硬膜外麻醉对腹部手术后感染情况及炎症因子、免疫功能、应激反应的影响。方法选取医院2012年1月-2015年11月行腹部手术患者104例为研究对象,按手术麻醉方式的不同分对照组与试验组,各52例,对照组采用气管插管全身麻醉;试验组采用气管插管全身麻醉复合硬膜外麻醉,于麻醉前(T0)、术后2h(T1)及术后1d(T2)时测定血清白细胞介素-1(IL-1)、IL-6、肿瘤坏死因子-α(TNF-α)、CD3+、CD4+、CD4+/CD8+、皮质醇、血糖水平,同时记录两组患者苏醒时间、拔管时间及术后感染状况。结果对照组T1、T2时和试验组T1时血清IL-1、IL-6、TNF-α水平较T0升高(P<0.05);与对照组比,试验组T1、T2时血清IL-1、IL-6、TNF-α水平较低(P<0.05);与T0比较,对照组T1、T2时和试验组T1时血清CD3+、CD4+、CD4+/CD8+水平降低(P<0.05),与对照组比,试验组T1、T2时血清CD3+、CD4+、CD4+/CD8+水平较高(P<0.05);与T0比,对照组T1、T2时和试验组T1时血清皮质醇、血糖升高(P<0.05),与对照组比,试验组T1、T2时血清皮质醇、血糖较低(P<0.05);对照组苏醒时间和拔管时间分别为(15.89±6.52)min和(22.14±8.96)min高于试验组(9.57±5.67)min、(14.62±7.75)min(P<0.05)。对照组术后感染率25.00%高于试验组9.62%(P<0.05)。结论气管插管全身麻醉复合硬膜外麻醉能降低腹部手术患者感染发生率,可能与降低术后炎症因子、应激反应,提高机体免疫功能相关,且安全性高,是一种有效的方案。

OBJECTIVE To investigate the effects of tracheal intubation general anesthesia and epidural anesthesia on the incidence of postoperative abdominal infections,inflammatory factors,immune function and stress response.METHODS A total of 104 cases of patients with elective abdominal surgery in our hospital from Jan.2012 to Nov.2015 were selected,and were divided into 2 groups according to the different surgical anesthesia methods,with 52 cases in each group.The control group was treated with tracheal intubation general anesthesia,and the study group was treated with tracheal intubation general anesthesia and epidural anesthesia.The serum IL-1,IL-6,TNF-α,CD3＋,CD4＋,CD4＋/CD8＋,cortisol and blood glucose level before anesthesia（T0）,2 hafter operation（T1）and 1 dafter operation（T2）were detected,the recovery time,extubation time and postoperative infection of the two groups were recorded.RESULTS Levels of IL-1,IL-6 and TNF-αin serum of T1 and T2 in control group and T1 in study group were significantly higher than those of T0（P〈0.05）.Compared with control group,the levels of serum IL-1,IL-6 and TNF-αof T1 and T2 in study group were significantly lower（P〈0.05）.Compared with T0,the serum levels of CD3＋,CD4＋and CD4＋/CD8＋of T1 and T2 in study group were significantly decreased（P〈0.05）.Compared with control group,the levels of serum CD3＋,CD4＋and CD4＋/CD8＋of T1 and T2 in study group were significantly higher（P〈0.05）.Compared with T0,the serum cortisol and blood glucose of T1 and T2 in control group and T1 in study group were significantly increased（P〈0.05）.Compared with control group,the serum cortisol and blood glucose of T1 and T2 in study group were significantly lower（P〈0.05）.The recovery time and extubation time of control group were（15.89±6.52）min and（22.14±8.96）min,which were significantly higher than（9.57±5.67）min and（14.62±7.75）min of study group（P〈0.05）.The postoperative infection rate of control group was25.00%,which was significantly higher than 9.62%of study group（P〈0.05）.CONCLUSIONTracheal intubation general anesthesia combined with epidural anesthesia in patients with abdominal surgery can significantly reduce the incidence of infections,and may be related to the reduction of postoperative inflammatory factors,stress response and improvement of the immune function of the body,with high safety,which is a kind of effective solution.