不同麻醉方式对老年腹部手术患者术后肺功能和炎症指标的影响

Impact of anesthesia modes on postoperative pulmonary function and inflammatory indexes of elderly patients undergoing abdominal surgery

目的对比两种不同麻醉方式对老年腹部手术患者术后肺功能和炎症指标的影响。方法选择2017年8月-2018年9月厦门大学附属第一医院行腹部手术患者100例,根据随机数表法分为试验组(n=50)和对照组(n=50)。对照组患者给予全身麻醉,试验组患者给予全身麻醉复合硬膜外麻醉。比较两组患者术前、术后1 d、3 d每分钟最大自主通气量(Maximum Autonomous Ventilation Volume per Minute,MVV)、每分钟静息通气量(Resting ventilation per minute,VE)、第一秒用力呼气量(Forced expiratory volume in the first second,FEV1)、残气量(Residual gas volume,RV)、总肺容量(Total lung capacity,TLC)等肺功能指标变化,CD3^+、CD4^+、CD8^+免疫功能指标,白细胞介素-6(Interleukin-6,IL-6)、白细胞介素-8(Interleukin-8,IL-8)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)的变化。观察并记录两组患者术后苏醒时间、拔管时间、麻醉时间、恢复自主呼吸时间等手术相关指标,比较两组肺部感染率。结果试验组患者术后苏醒时间(7.24±3.12)min、拔管时间(11.35±7.34)min、麻醉时间(4.13±1.14)h及恢复自主呼吸时间(7.34±1.54)min均短于对照组(P<0.05);试验组患者术后1 d、3 d MVV/FEV1水平[(89.25±7.80)%、(90.01±7.79)%]均高于对照组,RV/TLC水平[(32.12±4.29)%、(31.23±4.30)%]均低于对照组(P<0.05);试验组患者术后1 d CD3^+、CD4^+、CD8^+均高于对照组(P<0.05),IL-6、IL-8及TNF-α水平均低于对照组(P<0.05);两组患者术后3 d免疫指标及炎症因子与术前相比,差异均无统计学意义;试验组患者肺部感染率为6.00%(3/50)较对照组的22.00%(11/50)降低,差异有统计学意义(P<0.05)。结论全身麻醉复合硬膜外麻醉可显著降低老年腹部手术患者的术后肺部感染率,改善患者免疫状态和炎症反应及肺功能。

OBJECTIVE To observe and compare the impact of two anesthesia modes on postoperative pulmonary function and inflammatory indexes of the elderly patients undergoing abdominal surgery. METHODS A total of 100 patients who received abdominal surgery in the First Affiliated Hospital of Xiamen University from Aug 2017 to Sep 2018 were enrolled in the study and randomly divided into the experimental group with 50 cases and the control group with 50 cases.The control group was given general anesthesia, while the experimental group was given general anesthesia combined with epidural anesthesia.The lung function indexes such as maximum voluntary ventilation(MVV) per minute, resting ventilation per minute(VE), forced expiratory volume in the first second(FEV1), residual gas volume(RV) and total lung capacity and immune function indexes CD3^+, CD4^+ and CD8^+ as well as inflammatory indexes such as interleukin-6(IL-6), interleukin-8(IL-8) and tumor necrosis factor-α(TNF-α) were compared between the two groups of patients before the surgery and after the surgery for 1 and 3 days;the surgery-related indexes including postoperative recovery time, extubation time, anesthesia time and time of recovery of autonomous respiration were observed and recorded, and the incidence of pulmonary infection was compared. RESULTS The postoperative recovery time, extubation time, anesthesia time and time of recovery of autonomous respiration of the experimental group were respectively(7.24±3.12)min,(11.35±7.34)min,(4.13±1.14)h and(7.34±1.54)min, significantly shorter than those of the control group(P<0.05).The ratios of MVV to FEV1 of the experimental group were respectively(89.25±7.80)% and(90.01±7.79)% after the surgery for 1 and 3 days, higher than those of the control group.The ratios of RV to TLC of the experimental group were(32.12±4.29)% and(31.23±4.30)%, significantly lower than those of the control group(P<0.05).The levels of CD3^+, CD4^+ and CD8^+ of the experimental group were significantly higher than those of the control group after the surgery for 1 day(P<0.05);the levels of IL-6, IL-8 and TNF-α of the experimental group were significantly lower than those of the control group(P<0.05).There were no significant differences in the immunologic indexes and inflammatory factors between the two groups of patients after the surgery for 3 days.The incidence of pulmonary infection of the experimental group was 6.00%(3/50), significantly lower than 22.00%(11/50) of the control group(P<0.05). CONCLUSION The general anesthesia combined with epidural anesthesia may significantly reduce the incidence of postoperative pulmonary infection in the elderly patients undergoing abdominal surgery and improve the immune state as well as the lung function.