摘要
目的:探讨不同麻醉方案对择期行上腹部手术患者术后肺部感染的影响。方法:选取2015年6月-2016年10月在本院择期行上腹部开放手术的患者90例,随机分为静脉麻醉组、吸入麻醉组、硬膜外阻滞复合全麻组,每组30例。观察三组患者术后肺部感染情况、苏醒时间和拔管时间,采用荧光免疫流式细胞术检测麻醉前和术后6、24、72 h的T淋巴细胞亚群数量,计算CD4+/CD8+比值。结果:硬膜外阻滞复合全麻组的麻醉苏醒时间和拔管时间均明显短于静脉麻醉组和吸入麻醉组,差异均有统计学意义(P<0.05);静脉麻醉组与吸入麻醉组比较,差异均无统计学意义(P>0.05)。硬膜外阻滞复合全麻组术后感染率明显低于静脉麻醉组和吸入麻醉组,差异均有统计学意义(P<0.05);静脉麻醉组与吸入麻醉组比较,差异无统计学意义(P>0.05)。麻醉前,三组患者的CD4+、CD8+、CD4+/CD8+比较,差异均无统计学意义(P>0.05)。术后6、24、72 h,三组患者的CD4+、CD4+/CD8+均明显低于麻醉前,差异均有统计学意义(P<0.05);硬膜外阻滞复合全麻组术后72 h的CD4+、CD4+/CD8+内下降幅度均明显小于静脉麻醉组和吸入麻醉组,差异均有统计学意义(P<0.05)。结论:硬膜外阻滞复合全麻免疫抑制程度较低,有利于上腹部手术患者术后早期拔管,降低肺部感染风险。
Objective：To investigate the effect of different anesthetic methods on pulmonary infection in patients after elective upper abdominal surgery.Method：A total of 90 patients who underwent open abdominal surgery in our hospital from June 2015 to October 2016 were selected and randomly divided into the intravenous anesthesia group,inhalation anesthesia group and epidural block combined with general anesthesia group,30 cases in each group.The pulmonary infection,recovery time and extubation time of the three groups were observed,the number of T lymphocyte subsets was detected by immunofluorescence flow cytometry before anesthesia and at 6 h,24 h and 72 h after surgery,and the CD4^＋/CD8^＋ ratio were calculated.Result：The recovery time and extubation time of epidural block combined with general anesthesia group were significantly shorter than those of intravenous anesthesia group and inhalation anesthesia group,the differences were statistically significant（P〈0.05）;but there were no significant differences between the intravenous anesthesia group and the inhalation anesthesia group（P〉0.05）.The postoperative infection rate of epidural block combined with general anesthesia group was significantly lower than those of intravenous anesthesia group and inhalation anesthesia group,the differences were statistically significant（P〈0.05）;but there was no significant difference between the intravenous anesthesia group and the inhalation anesthesia group（P〉0.05）.There were no significant differences in CD4^＋,CD8^＋ and CD4^＋/CD8^＋ among the three groups before anesthesia（P〉0.05）.6 h,24 h and 72 h after surgery,CD4^＋ and CD4^＋/CD8^＋ in the three groups were significantly lower than those before anesthesia,the differences were statistically significant（P〈0.05）.The decrease of CD4^＋ and CD4^＋/CD8^＋ in the epidural block combined with general anesthesia group within 72 h after surgery were significantly lower than those in the intravenous anesthesia group and inhalation anesthesia group,the differences were statistically significant（P〈0.05）.Conclusion：The immunosuppression degree of epidural block combined with general anesthesia is relatively lower,which is beneficial to early extubation and lowering risk of pulmonary infection in patients undergoing upper abdominal surgery.
出处
《中国医学创新》
CAS
2017年第18期45-48,共4页
Medical Innovation of China
关键词
麻醉
上腹部手术
肺部感染
Anesthesia
Upper abdominal surgery
Pulmonary infection
