硬膜外自控镇痛对原发性肝癌肝部分切除术患者院内感染及炎症因子的影响

Effect of patient-controlled epidural analgesia on nosocomial infection in patients with primary liver cancer undergoing partial hepatectomy

目的探讨硬膜外自控镇痛对原发性肝癌部分肝切除患者院内感染及炎症因子的影响。方法将86例行原发性肝癌肝部分切除术患者按照随机数字表法分为硬膜外镇痛组(E组)与静脉镇痛组(I组),每组43例。E组给予硬膜外阻滞复合全身麻醉及术后硬膜外自控镇痛(PCEA),I组采用全身麻醉及术后静脉自控镇痛(PCIA)。比较两组患者术后6h(T_1)、24h(T_2)、48h(T_3)视觉模拟评分(VAS)、术后48h患者自控镇痛(PCA)次数、下呼吸道感染情况及术后24h炎症因子水平。结果经过不同的镇痛方式,E组患者T_1、T_2、T_3的VAS评分及48hPCA次数和I组比较,差异均无统计学意义(均P>0.05);手术后,E组下呼吸道感染发生率为9.30%(4/43),I组为27.91%(12/43),差异有统计学意义(P<0.05),E组下呼吸道感染发生率明显低于I组;E组患者手术后24h的血清T_NF-α、超敏C反应蛋白(hs-CRP)、IL-6和降钙素原(PCT_)水平均低于I组,差异均有统计学意义(均P<0.05)。结论硬膜外自控镇痛可以缓解原发性肝癌部分肝切除术后疼痛症状,降低患者炎症因子水平,减轻呼吸道感染的发生风险。

Objective To investigate the effect of epidural self-control analgesia on nosocomial infection in patients withprimary liver cancer undergoing partial hepatectomy. Methods Eighty six patients with primary liver cancer undergoing partialhepatectomy in Department of Hepatobiliary Surgery in our hospital were enrolled in the study. The patients were randomlydivided into two groups with 46 cases in each group. Patients in group E received epidural combined general anesthesiaand postoperative epidural analgesia （PCEA）, while patients in the group I received general anesthesia and postoperativeintravenous controlled analgesia （PCIA）. The VAS score at 6h （T1）, 24h （T2） and 48h （T3） after operation, the times of PCA at48h after operation, lower respiratory tract infection and inflammatory factors at postoperative 24h were compared betweenthe two groups. Results There were no significant differences in the VAS score at T1, T2, T3 and PCA times at 48h betweengroups E and I （all P〉0.05）. The incidence of lower respiratory tract infection was 9.30%（4/43） in group E and 27.91% （12/43） ingroup I （P〈0.05）. The incidence of lower respiratory infection in group E was significantly lower than that in group I. The levels ofserum TNF-α, hs-CRP, IL-6 and PCT in group E were significantly lower than those in group I at 24s after operation （all P〈0.05）. Conclusion Epidural patient-controlled analgesia can significantly reduce the levels of inflammatory factors, the risk ofrespiratory infection and provide similar analgesic effect as PCIA in patients with primary liver cancer undergoing partial hepatectomy.