全麻复合硬膜外麻醉与单纯全麻对老年腹部手术患者肺部感染及肺功能的影响

Effect of combined general-epidural anesthesia versus general anesthesia on pulmonary infection and lung function in senile patients with abdominal operation

目的探讨全身麻醉(全麻)复合连续硬脊膜外阻滞麻醉与单纯全麻在老年腹部手术患者中的应用效果。方法选取2015年9月-2017年3月该院收治的90例行腹部手术患者,利用随机数表法分为两组,各45例。观察组采取全麻复合硬膜外麻醉,对照组采取单纯全麻,对比两组患者麻醉前、术后1d、3d及拔管后肺功能指标、术后苏醒时间、拔管时间及肺部感染情况。结果术后1d、3d两组患者每分钟最大通气量(MVV)/第1s用力呼气量(FEV1)较麻醉前降低,残气量(RV)/肺总量(TLC)较麻醉前升高,且观察组改变幅度较对照组低,差异有统计学意义(P<0.05);拔管后,观察组患者呼吸频率(RR)、血氧饱和度(SpO2)及分钟通气量(MV)指标均优于对照组,差异有统计学意义(P<0.05);观察组术后苏醒时间及拔管时间均较对照组短,肺部感染发生率较对照组低,差异有统计学意义(P<0.05)。结论与单纯全麻相比,全麻复合连续硬脊膜外阻滞麻醉可有效减少对老年腹部手术患者肺功能的影响,降低肺部感染率,还可缩短术后苏醒时间及拔管时间。

【Objective】 To investigate the application effects of combined general-epidural anesthesia (CGEA) anesthesia (GA) in senile patients treated with abdominal operation.【Methods】 Ninety patients underwent abdominal operation in our hospital from September 2015 to March 2017 were selected, and they were divided into two groups by random number table, 45 cases in each group. Observation group was given CGEA, while control group was given GA. The indexes of lung function, postoperative awakening time, extubation time, pulmonary infection before anesthesia, at the 1st day and 3rd day after operation, after extubation were compared between the two groups.【Results】 At the 1st day and 3rd day after operation, the MW/FEV1 in two groups decreased compared with that before anesthesia, the RV/TLC increased compared with that before anesthesia, the changing range of observation group was lower than that of control group (P<0.05);after extubation, the RR, Sp02) MV in observation group were better than those in control group (P <0.05);the postoperative awakening time and extubation time in observation group were shorter than those in control group, the incidence of pulmonary infection was lower than that in control group (P<0.05).【Conclusion】 Compared with GA,CGEA for senile patients undergoing abdominal operation can effectively reduce the effect on lung fianction, decrease the incidence of pulmonary infection, and shorten postoperative awakening time and extubation time.