全身麻醉复合硬膜外麻醉对胃癌根治术患者肺功能及术后肺部感染的影响  

Influence of general anesthesia combined with epidural anesthesia on lung function and postoperative pulmonary infections in patients undergoing gastrectomy

作　　者：王泽华[1] 胡文庆[2] 郭焱[1] 方宏[1] 姜涛[1] 

机构地区：[1]长治医学院附属和济医院麻醉科,山西长治046000 [2]长治医学院附属和济医院普外科,山西长治046000

出　　处：《中华医院感染学杂志》2017年第6期1301-1304,共4页Chinese Journal of Nosocomiology

基　　金：山西省卫生厅医药科技计划基金资助(21052382)

摘　　要：目的分析全身麻醉复合硬膜外麻醉对胃癌根治术患者肺功能及术后肺部感染的影响。方法选择2014年1月-2015年12月在医院行胃癌根治术患者200例,分为观察组及对照组,观察组使用全身麻醉复合硬膜外麻醉,对照组使用单纯全身麻醉,比较两组患者围术期中各项肺功能指标,麻醉恢复时间,肺部感染率及肺部感染病原菌分布情况。结果与术前1天的基础值相比,术后第1、3天,对照组(MVV-VE)/FEV1及MVV/FEV1均显著降低,RV/TLC%显著升高,而观察组与术前基础值相比无明显变化;在术后相同时间点,观察组三项指标均优于对照组;与对照组相比,观察组患者麻醉恢复时间均明显缩短,术后肺部感染率明显降低,肺部感染患者的主要病原菌为革兰阴性菌,以铜绿假单胞菌及大肠埃希菌为主。结论胃癌根治术患者使用全身麻醉复合硬膜外麻醉对患者肺功能影响小,而且可降低术后肺部感染的发生率,利于患者预后。OBJECTIVE To observe the influence of general anesthesia combined with epidural anesthesia on lung function and postoperative pulmonary infections in patients undergoing gastrectomy.METHODS A total of 200 patients who underwent the gastrectomy in the hospital from Jan 2014 to Dec 2015 were enrolled in the study and divided into the observation group and the control group.The observation group was treated with general anesthesia combined with epidural anesthesia,while the control group was treated with single general anesthesia.The perioperative lung function indexes,time of recovery of anesthesia,incidence of pulmonary infections,and distribution of pathogens causing pulmonary infections were observed and compared between the two groups of patients.RESULTS As compared with the baseline value,the（MVV-VE）/FEV1 and MVV/FEV1 of the control group were significantly lower after the surgery for 1and 3days than 1day before the surgery,the RV/TLC% was remarkably elevated,however,there was no significant change in the baseline value in the observation group before and after the surgery.Three indexes of the observation group were better than those of the control group at the same time points after the surgery.The anesthesia recovery time of the observation group was remarkably shorter than that of the control group,and the incidence of postoperative pulmonary infection was significantly reduced.The gram-negative bacteria were dominant among the pathogens isolated from the patients with pulmonary infection,among which Pseudomonas aeruginosa and Escherichia coli were the predominant species.CONCLUSION The general anesthesia combined with epidural anesthesia has less impact on the lung function of the patients undergoing gastrectomy,and it may reduce the incidence of postoperative pulmonary infection and facilitate the prognosis of the patients.

关 键 词：全身麻醉复合硬膜外麻醉 胃癌根治术 肺功能 肺部感染 

分 类 号：R614[医药卫生—麻醉学]