全身复合第8-9椎间缝硬膜外麻醉联合多模式镇痛在老年上腹部手术中的应用效果

Efficacy of General and 8th-9th Intervertebral Space Epidural Anesthesia Combined with Multimodal Analgesia in Elderly Patients Undergoing Upper Abdominal Surgery

目的探讨全身复合第8-9椎间缝硬膜外麻醉联合多模式镇痛(MMA)对老年上腹部手术患者疼痛、麻醉指标及T淋巴细胞亚群的影响。方法将131例行上腹部手术的老年患者按随机数字表法分为2组:对照组65例给予静脉全身麻醉结合MMA,观察组66例给予全身复合第8-9椎间缝硬膜外麻醉联合MMA。比较2组患者的疼痛程度(VAS评分)、麻醉指标(自主呼吸恢复时间、呼之睁眼时间、拔管时间及定向恢复时间)、T淋巴细胞亚群水平(包括CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))以及术后肺部相关并发症发生情况。结果观察组术后VAS评分较对照组显著减少(P<0.05),自主呼吸恢复时间、呼之睁眼时间、拔管时间及定向恢复时间较对照组显著缩短(P<0.05),CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平较对照组显著增加(P<0.05),术后肺部相关并发症发生率较对照组显著减少(P<0.05)。结论全身复合第8-9椎间缝硬膜外麻醉联合MMA用于老年上腹部手术效果显著,可通过阻断中枢神经传导以及缩短麻醉药物分解时间等有效改善患者疼痛、麻醉指标及T淋巴细胞亚群水平。

Objective To investigate the effects of general and 8th-9th intervertebral space epidural anesthesia combined with multimodal analgesia(MMA)on pain,anesthesia indexes and T lymphocyte subsets in elderly patients undergoing upper abdominal surgery.Methods A total of 131 elderly patients undergoing upper abdominal surgery were randomly divided into two groups.The control group(65 patients)was given intravenous general anesthesia and MMA.The observation group(66 patients)received general and 8th-9th intervertebral space epidural anesthesia combined with MMA.Pain degree(VAS score),anesthesia indicators(time to spontaneous breathing recovery,eye opening,extubation and directed recovery),T lymphocyte subsets(CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)),and postoperative pulmonary complications were compared between the two groups.Results Compared with the control group,VAS score,time to spontaneous breathing recovery,eye opening,extubation and directed recovery and incidence of postoperative pulmonary complications decreased,and levels of CD3^(+),CD4^(+) and CD4^(+)/CD8^(+) increased in the observation group(P<0.05).Conclusion General and 8th-9th intervertebral space epidural anesthesia combined with MMA can effectively improve pain,anesthesia indicators and T lymphocyte subsets by blocking central nerve conduction and shortening the time of anesthetic drug decomposition in elderly patients undergoing upper abdominal surgery.