麻醉与镇痛方式对胃癌患者术后下呼吸道感染的影响  

Effects of anesthesia and analgesia on lower respiratory tract infections in patients with gastric cancer

作　　者：王建科 程林[2] 程晓林 钱楚晖 田小霞 

机构地区：[1]当阳市人民医院麻醉科,湖北当阳444100 [2]宜昌市中心人民医院麻醉科,湖北宜昌443003 [3]三峡大学仁和医院麻醉科,湖北宜昌443001

出　　处：《中华医院感染学杂志》2017年第19期4457-4460,共4页Chinese Journal of Nosocomiology

基　　金：湖北省科技攻关计划基金资助项目(2004AA301C49)

摘　　要：目的分析不同麻醉与镇痛方式对胃癌患者术后下呼吸道感染的影响。方法选取医院2014年7月-2016年7月收治的200例胃癌患者为研究对象,随机分为甲组54例、乙组54例、丙组46例、丁组46例,四组患者术前诱导麻醉方式均相同,术中麻醉与术后镇痛方式分别为:甲组术中吸入麻醉药维持全身麻醉+术后静脉自控镇痛(PCVA);乙组术中吸入麻醉药维持全身麻醉+术后硬膜外自控镇痛(PCEA);丙组术中硬膜外复合全身麻醉+术后静脉自控镇痛(PCVA);丁组术中硬膜外复合全身麻醉+术后硬膜外自控镇痛(PCEA),分析患者下呼吸道感染情况、镇痛效果及血气指标。结果丁组下呼吸道感染率显著低于甲、乙、丙组,乙组及丙组感染率明显低于甲组(P<0.05),但乙组与丙组比较差异无统计学意义;甲组与丙组、乙组与丁组VAS疼痛评分差异无统计学意义;乙、丁组VAS疼痛评分明显低于甲、丙组,差异有统计学意义(P<0.05);甲组与乙组、丙组与丁组各项血气指标差异无统计学意义,但丙、丁组与甲、乙组差异有统计学意义(P<0.05)。结论胃癌患者术中选择硬膜外复合全身麻醉方式以及术后硬膜外自控镇痛方式不仅能明显减少患者术后下呼吸道感染的发生率,同时减轻术后疼痛程度,提高患者术后生活质量,具有较高的临床参考价值。OBJECTIVE To analyze the effects of different anesthesia and analgesia methods on lower respiratory tract infections in patients with gastric cancer.METHODS A total of 200 cases of patients with gastric cancer treated in hospital from Jul.2014 to Jul.2016 were selected as the research subjects,and were randomly divided into group A（54cases）,B（54cases）,C（46cases）,and D（46cases）.Patients in the four groups were given the same induced anesthesia before operation.The intraoperative anesthesia and postoperative analgesia of the 4groups were：group A with inhalation anesthetic for intraoperative anesthesia and postoperative patient-controlled intravenous analgesia（PCVA）,group B with inhalation anesthetic for intraoperative anesthesia and postoperative patient-controlled epidural analgesia（PCEA）,group C with intraoperative epidural anesthesia and postoperative patient-controlled intravenous analgesia（PCVA）,and group D with intraoperative epidural anesthesia and postoperative patient-controlled epidural analgesia（PCEA）.The lower respiratory tract infection situation,analgesic effect and blood gas indexes of the patients were analyzed.RESULTS The lower respiratory tract infection rate in group D was significantly lower than that of group A,B and C,the lower respiratory tract infection rate in group B and C was significantly lower than that in group A（P〈0.05）,but no significant difference was found between group B and C.Group A and C,group B and D had no significant difference in VAS pain score.The VAS pain score in group B and D was significantly lower than that of group A and C（P〈0.05）.There was no significant difference in the blood gax indexes between Group A and Group B,Group C and Group D,hoeever,there was significant difference between Group C and Group A,Group D and Group B（P〈0.05）.CONCLUSIONSelection of intraoperative epidural anesthesia and postoperative epidural analgesia in gastric cancer patients can not only significantly reduce the incidence of postoperative

关 键 词：麻醉与镇痛方式 胃癌患者术后 下呼吸道感染 影响 

分 类 号：R614[医药卫生—麻醉学]