不同麻醉方式对伴糖尿病手术患者术后感染与血流动力学及血糖指标的影响研究

Influence of anesthesia modes on postoperative infection,hemodynamics and blood glucose indexes of surgery patients with diabetes mellitus

目的分析Jorg Bubeck法硬膜外麻醉和常规硬膜外麻醉对伴糖尿病手术患者术后感染、血流动力学及血糖指标的影响。方法选取2016年5月-2017年5月医院收治的伴糖尿病患者160例作为研究对象,按随机数字表法分为研究组和对照组,每组各80例,其中对照组采用常规硬膜外麻醉;研究组选择Jorg Bubeck法硬膜外麻醉。观察并比较两组患者在术后不同时间点感染发生情况,以及手术进行过程中不同时间点血糖水平及血流动力学改变情况。结果研究组在术后48h和72h的感染率为7.50%和8.75%,均低于对照组的18.75%和22.50%,两组比较差异有统计学意义(χ~2=4.440、5.736,P<0.05);研究组患者麻醉诱导前(T1)、切皮时(T2)、静脉注射5min后(T3)、手术开始20min(T4)、手术结束时(T5)血流动力学指标心率、平均动脉压、收缩压、舒张压比较差异有统计学意义(P<0.05);两组患者各时间点血糖水平比较差异无统计学意义。结论与常规硬膜外麻醉相比,采取Jorg Bubeck法硬膜外麻醉有助于保持伴糖尿病手术患者血流动力学稳定,而且术后感染率低,是一种较佳的麻醉方式。

OBJECTIVE To observe the influence of Jorg Bubeck epidural anesthesia and conventional epidural anesthesia on postoperative infection,hemodynamics and blood glucose indexes of the surgery patients with diabetes mellitus.METHODS A total of 160 patients who were complicated with diabetes mellitus and treated in hospitals from May 2016 to May 2017 were recruited as the study objects and randomly divided into the study group and the control group,with 80 cases in each group.The control group was treated with conventional epidural anesthesia,and the study group was given Jorg Bubeck epidural anesthesia.The incidence of infection was compared between the two groups of patients after the surgery for different time period,and the levels of blood glucose and hemodynamics indexes were observed during the surgery.RESULTS The infection rate of the study group was 7.50%after the surgery for 48 hours,lower than 18.75%of the control group;the infection rate of the study group was8.75%after the surgery for 72 hours,lower than 22.50%of the control group,and there were significant differences between the two groups(χ~2=4.440,5.736,P<0.05).There were significant differences in the hemodynamics indexes heart rate,mean arterial pressure,systolic pressure and diastolic pressure among the patients of the study group at pre-anesthesia induction(T1),skin incision(T2),5 minutes after intravenous injection(T3),20 minutes after surgery(T4),and end of surgery(T5)(P<0.05);there was no significant difference in the blood glucose level between the two groups of patients at the time points.CONCLUSION As compared with conventional epidural anesthesia,Jorg Bubeck epidural anesthesia may facilitate the stability of hemodynamics indexes of the surgery patients complicated with diabetes mellitus,with the incidence of postoperative infection low,and it is a better anesthesia mode.