静脉麻醉与硬膜外麻醉对十二指肠胰头癌老年患者术后肺部感染的影响分析  

Effects of epidural block anesthesia and intravenous anesthesia on postoperative pulmonary infections in elderly patients with duodenal pancreatic head carcinoma

作　　者：杨涛[1] 周日永[1] 张竞雄[1] 张学政[1] 徐旭仲[1] 刘丽萍[2] 

机构地区：[1]温州医科大学附属第一医院麻醉科,浙江温州325000 [2]湖南省人民医院小儿心脏科,湖南长沙410001

出　　处：《中华医院感染学杂志》2016年第9期2050-2052,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(30971105)

摘　　要：目的探讨全凭静脉麻醉与硬膜外阻滞复合静脉麻醉对老年十二指肠胰头癌术后肺部感染的影响,为制定感染控制方案提供客观依据。方法选取2013年1月-2015年7月的80例老年十二指肠胰头癌手术患者为研究对象,根据其麻醉方式分为观察组和对照组,各40例;观察组患者应用硬膜外阻滞复合静脉麻醉,对照组患者应用全凭静脉麻醉,对两组患者麻醉前、后的呼吸功能指标、外周血T淋巴细胞亚群指标及自主呼吸恢复时间、睁眼时间、拔管时间、术后肺部感染临床表现、术后肺部感染率进行比较。结果麻醉后观察组患者的各项呼吸功能指标、外周血T淋巴细胞亚群指标均优于对照组(P<0.05);自主呼吸恢复时间、睁眼时间、拔管时间等均显著短于对照组(P<0.05);出现各类肺部感染临床表现的比例及肺部感染率均显著低于对照组(P<0.05)。结论老年十二指肠胰头癌患者手术中应用硬膜外阻滞复合静脉全麻,能够有效保护其呼吸功能和免疫功能,术后苏醒较快,可降低术后肺部感染率。OBJECTIVE To observe the influence of single intravenous anesthesia and epidural block anesthesia combined with intravenous anesthesia on postoperative pulmonary infections in elderly patients with duodenal pancreatic head carcinoma so as to put forward the measures to control the infections.METHODS A total of 80 elderly patients with duodenal pancreatic head carcinoma who underwent surgeries from Jan 2013 to Jul 2015 were recruited as the study objects and divided into the observation group and the control group according to the way of anesthesia,with 40 cases in each.The observation group was treated with epidural block anesthesia combined with intravenous anesthesia,while the control group was given single intravenous anesthesia.The respiratory function indicators,indicators of peripheral blood T lymphocyte subsets,time of recovery of spontaneous breathing,time of opening eyes,extubation time,clinical manifestations of postoperative pulmonary infections,and incidence of postoperative pulmonary infections were observed and compared between the two groups of patients before and after the anesthesia.RESULTS The respiratory function indicators and indicators of peripheral blood T lymphocyte subsets of the observation group were significantly better than those of the control group after the anesthesia（P〈0.05）.The time of recovery of spontaneous breathing,time of opening eyes,and extubation time were significantly shorter in the observation group than in the control group（P〈0.05）.The proportion of the patients with various clinical manifestations of pulmonary infections and incidence rate of pulmonary infections were significantly lower in the observation group than in the control group（P〈0.05）.CONCLUSION The epidural block combined with intravenous anesthesia can effectively protect the respiratory function and immune function of the elderly patients with duodenal pancreatic head carcinoma and reduce the incidence of postoperative pulmonary infections,with the postoperative recovery rapid.

关 键 词：老年患者 十二指肠胰头癌 术后感染 肺部感染 麻醉方式 

分 类 号：R614[医药卫生—麻醉学]