腹部手术患者不同麻醉镇痛方式对术后下呼吸道感染的影响  

Effects of different narcotic analgesic methods on postoperative respiratory infections in patients undergoing abdominal surgery

作　　者：高项羽[1] 刘喆[1] 孙凯[2] 付红光[2] 

机构地区：[1]南阳市中心医院麻醉科,河南南阳473001 [2]郑州大学第二附属医院麻醉科,河南郑州450014

出　　处：《中华医院感染学杂志》2015年第12期2799-2801,共3页Chinese Journal of Nosocomiology

基　　金：河南省自然科学基金资助项目(324410127)

摘　　要：目的比较观察不同麻醉镇痛方式对腹部手术患者术后下呼吸道感染的影响,为合理选择麻醉镇痛方式提供依据。方法回顾性分析医院2010年9月-2013年3月53例采用单纯全身麻醉及术后静脉自控镇痛(A组)和67例硬膜外麻醉及术后硬膜外自控镇痛(B组),进行腹部手术患者临床资料,比较两组麻醉效果、血气分析指标及下呼吸道感染率。结果 A组下呼吸道感染率为34.0%,明显高于B组的17.9%,差异有统计学意义(P<0.05);A组共分离出26株病原菌,其中革兰阴性菌19株占73.0%、革兰阳性菌7株占27.0%,B组共分离出18株病原菌,其中革兰阴性菌14株占77.8%、革兰阳性菌4株占22.2%,两组病原菌分布比较差异无统计学意义;A、B两组的麻醉优良率分别为92.5%、91.0%,两组比较差异无统计学意义;两组患者术后pH值、动脉血氧分压、动脉血二氧化碳分压、血氧饱和度水平比较差异无统计学意义。结论单纯全身麻醉及术后静脉自控镇痛和硬膜外麻醉及术后硬膜外自控镇痛,对进行腹部手术患者均是有效的麻醉镇痛方式,但后者发生下呼吸道感染的机会更低,值得临床推广应用。OBJECTIVE To compare the effects of different narcotic analgesic methods on postoperative respiratory infections in patients undergoing abdominal surgery ,so as to provide evidences for rationally selection of narcotic analgesic methods .METHODS The clinical characters of patients undergoing abdominal surgery were analyzed ret‐rospectively including 53 cases using simple general anesthesia and postoperative intravenous analgesia （group A） and 67 cases using epidural anesthesia and postoperative epidural analgesia（group B） .The clinical data ,anesthesia effect ,blood gas and lower respiratory tract infections were compared between two groups .RESULTS The lower respiratory tract infection rate in group A was 34 .0% ,significantly higher than 17 .9% in group B（P〈0 .05） . Totally 26 stains of pathogens were isolated from group A ,of which 19 strains of gram‐negative bacteria accounted for 73 .1% and 7 strains of gram‐positive bacteria accounted for 26 .9% .Totally 18 stains of pathogens were isola‐ted from group B ,of which 14 strains of gram‐negative bacteria accounted for 77 .8% and 4 strains of gram‐posi‐tive bacteria accounted for 22 .2% . There was no significant difference in pathogen distribution between two groups .The anesthetic good rates in groups A and B were 92 .5% ,91 .0% ,with no significant difference between two groups .There were no significant differences in levels of pH ,arterial oxygen partial pressure （PaO2 ） ,arteri‐al carbon dioxide partial pressure （PaCO2 ） ,and oxygen saturation （SpO2 ） between two groups .CONCLUSION Simple general anesthesia and postoperative intravenous analgesia as well as epidural anesthesia and postoperative epidural analgesia for abdominal surgery are effective analgesia ways ,but the latter has less chance of lower respir‐atory tract infections ,which is worthy of clinical application .

关 键 词：腹部手术 下呼吸道感染 麻醉镇痛 

分 类 号：R563.1[医药卫生—呼吸系统]