不同麻醉方式对老年患者胃癌术后肺部感染的影响  

Effect of different anesthetic approaches on postoperative pulmonary infection in elderly patients after gastric cancer surgery

作　　者：王中胜[1] 刘志莲[1] 刘英[1] WANG Zhong-Sheng LIU Zhi-Lian LIU Ying(Department of Anesthesiology, Luzhou Hospital of Traditional Chinese Medicine, Luzhou 646100, China)

机构地区：[1]泸州市中医医院麻醉科,泸州646100

出　　处：《中华老年多器官疾病杂志》2017年第4期279-282,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的探讨不同麻醉方式对老年患者胃癌术后肺部感染的影响。方法入选2013年3月至2016年3月泸州市中医医院收治的老年胃癌患者100例,根据麻醉方式,采用随机数字表法将患者分为全凭静脉麻醉(TIVA)组、吸入全身麻醉(IA)组和硬膜外麻醉联合静脉全身麻醉(CE-IVA)组,分别于麻醉前、拔管后5 min测定呼吸频率(RR)、血氧饱和度(SaO_2)和分钟通气量(MV),手术完毕停药后监测患者苏醒时间和拔管时间,术后第3天监测患者有无肺部感染。结果相比麻醉前,三组患者拔管后RR升高,SaO_2和MV降低,差异有统计学意义(P<0.05)。相比TIVA组和IA组患者,CE-IVA组患者拔管后RR降低,而SaO_2和MV升高,苏醒时间和拔管时间明显缩短,肺部感染率降低,差异有统计学意义(P<O.05)。结论硬膜外麻醉联合静脉全身麻醉可改善患者肺功能,显著降低患者术后肺部感染发生率。Objective To determine the effect of different anesthetic approaches on postoperative pulmonary infection in the elderly patients after gastric cancer surgery.Methods A total of 100 elderly patients with gastric cancer who were treated surgically in our hospital from March 2013 to March 2016 were recruited in this study.They were randomly divided into total intravenous anesthesia group （TIVA, n=32）, inhalation anesthesia group （IA, n=30）, and combined epidural-intravenous anesthesia group （CE-IVA, n=38）.Respiratory rate （RR）, blood oxygen saturation （SaO2） and minute ventilation （MV） were measured before anesthesia and in 5 min after extubation.The recovery time and extubation time were monitored after the operation was finished.On the 3rd day after operation, the incidence of postoperative pulmonary infection was observed in the subjects.Results Significantly elevated RR and reduced SaO2 and MV were observed in all the 3 groups of patients after extubation than before surgery （P〈0.05）.The CE-IVA group had obviously lower RR, higher SaO2 and MV, shorter recovery time and extubation time, and lower incidence of pulmonary infection when compared with the other 2 groups （P〈0.05）.Conclusion Combined epidural-intravenous anesthesia can improve respiratory function and reduce the incidence of postoperative pulmonary infection in elderly patients after gastric cancer surgery.

关 键 词：胃癌 麻醉 肺部感染 老年 

分 类 号：R614[医药卫生—麻醉学]