硬膜外自控镇痛对胸部手术患者术后感染及炎性指标的影响研究  

Effects of epidural analgesia on postoperative infections and inflammatory indexes in patients with thoracic surgery

作　　者：刘喆[1] 周勇[1] 张军[1] 高项羽[1] 李铮[1] 李丰[1] 

机构地区：[1]郑州大学附属医院南阳市中心医院麻醉科,河南南阳473000

出　　处：《中华医院感染学杂志》2016年第15期3458-3460,共3页Chinese Journal of Nosocomiology

基　　金：河南省卫生厅基金资助项目(201401027)

摘　　要：目的探讨硬膜外自控镇痛对胸部手术患者术后发生感染及炎性指标的影响,以寻找降低术后感染发生率方法。方法收集医院2012年1月-2015年1月收治行开胸手术患者184例,随机单盲取法分为观察组与对照组各92例,对照组术后给予常规抗炎及口服、肌内注射止痛药物,观察组术后给予常规抗炎及硬膜外自控镇痛。观察两组患者术后5d内感染情况。结果观察组患者感染率3.26%,低于对照组11.96%,差异有统计学意义(P<0.05);两组术前炎性指标超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-a(TNF-α)、白介素-6(IL-6)、白介素-8(IL-8)及重组人白介素-1β(IL-1β)对比,差异均无统计学意义;观察组术后1d各项炎性指标均低于术后3d及对照组同期(P<0.05),术后3d高于术前,低于对照组同期(P<0.05)。结论胸部术后给予硬膜外自控镇痛,可降低术后疼痛程度、改善肺部功能、降低炎性因子水平,从而降低术后感染发生率,值得临床推广。OBJECTIVE To investigate the effects of epidural analgesia on postoperative infection and inflammatory indexes of patients with thoracic surgery,so as to find a way to reduce the incidence of postoperative infections.METHODS A total of 184 cases of patients underwent open chest surgery in our hospital from Jan.2012 to Jan.2015 were selected,and randomly divided into observation group and control group by single blind method,with92 cases in each group.Patients in control group were given conventional anti-inflammatory and analgesic oral,intramuscular injection,and in observation group were given conventional anti-inflammatory and patient-controlled epidural analgesia.The infection of of the two groups within 5dafter surgery was observed.RESULTS The infection rate of observation group was 3.26%,which was lower than 11.96% of control group（P〈0.05）.The inflammatory indexes high sensitive C reactive protein（hs-CRP）,tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6）,interleukin-8（IL-8）and recombinant human interleukin-1β（IL-1β）of the two groups had no significant difference.One day after surgery,the inflammatory indexes of observation group were lower than those of 3dafter surgery and those of control group at the same time（P〈0.05）,and 3dafter surgery,those of observation group were higher than those of before surgery,and lower than those of control group at the same time（P〈0.05）.CONCLUSIONPostoperative epidural analgesia can reduce postoperative pain,improve lung function and reduce the level of inflammatory factors,so as to reduce the incidence of postoperative infection,and it is worthy of clinical promotion.

关 键 词：硬膜外自控镇痛 胸部手术 术后感染 炎性指标 

分 类 号：R655[医药卫生—外科学]