全身麻醉复合硬膜外麻醉对老年肝癌患者心肺功能和术后肺部感染的影响  

Influence of general anesthesia combined with epidural anesthesia on cardiopulmonary function and postoperative pulmonary infection in elderly patients with liver cancer

作　　者：侯传新[1] 姚光[1] 安磊[1] 王建营[1] 彭井印 HOU Chuan-xin;YAO Guang;AN Lei;WANG Jian-ying;PENG Jing-yin(Binzhou Medical University Hospital, Binzhou , Shandong 256603, Chin)

机构地区：[1]滨州医学院附属医院麻醉科,山东滨州256603

出　　处：《中华医院感染学杂志》2018年第9期1377-1379,1383,共4页Chinese Journal of Nosocomiology

摘　　要：目的探究全身麻醉复合硬膜外麻醉对老年肝癌患者心肺功能和术后肺部感染的影响。方法选取医院2014年12月-2016年12月期间收治的100例老年肝癌患者作为研究对象。依麻醉方式分为对照组和试验组,各50例,对照组在单纯全身麻醉条件下进行肝癌切除手术,试验组在全身麻醉复合硬膜外麻醉条件下进行肝癌切除手术。比较两组患者术前1d、术后1d及术后3d心功能指标心率(HR)、平均动脉压(MAP)、血氧饱和度(SaO2)及肺功能指标每分钟最大通气量(MVV)/第一秒用力呼气量(FEV1)、残气量(RV)/肺总量(TLC)及术后肺部感染情况。结果两组患者术后1d、3d的HR、MAP与术前1d相比均升高,SaO2均下降,且试验组在术后1d、3d的HR、MAP值低于对照组,SaO2高于对照组(P<0.05);术后1d、3d的MVV/FEV1与术前1d相比均有下降,RV/TLC值均有升高,且试验组术后1d、3d的RV/TLC值低于对照组,MVV/FEV1值高于对照组(P<0.05);对照组术后12例患者发生感染,试验组3例发生感染,两组比较差异有统计学意义(χ2=3.6027,P=0.032)。结论全身麻醉复合硬膜外麻醉对老年肝癌患者心肺功能影响较小,可降低术后患者肺部感染率,值得在临床推广。OBJECTIVE To explore the influence of general anesthesia combined with epidural anesthesia on cardiopulmonary function and postoperative pulmonary infection in elderly patients with liver cancer.METHODS A total of 100 elderly patients with liver cancer who were treated in the hospital from Dec 2014 to Dec 2016 were recruited as the study objects and divided into the experimental group and the control group according the anesthesia mode,with 50 cases in each group.The control group received hepatectomy under single general anesthesia,while the experimental group received hepatectomy under the general anesthesia combined with epidural anesthesia.The heart rate（HR）,mean arterial pressure（MAP）,arterial oxygen saturation（SaO2）,maximum ventilation volume（MVV）/forced expiratory volume in 1 second（FEV1）,residual volume（RV）/total lung capacity（TLC）and incidence of postoperative pulmonary infection were observed and compared bertween the two groups of patients before the surgery for 1 day and after the surgery for 1 day and 3 days.RESULTS The HR and MAP of the two groups of patients were higher after the surgery for 1 day and 3 days than before the surgery for 1 day,the SaO2 was reduced;the HR and MAP of the experimental group were significantly lower than those of the control group after the surgery for 1 day and 3 days,while the SaO2 of the epxerimental group was significantly higher than that of the control group（P〈0.05）.The MVV/FEV1 was significantly lower after the surgery for 1 day and3 days than before the surgery for 1 day,the RV/TLC was significantly elevated;the RV/TLC of the experimental group was significantly lower than that of the control group after the surgery for 1 day and 3 days,while the MVV/FEV1 of the experimental group was significantly higher than that of the control group（P〈0.05）.Totally12 patients had postoperative infection in the control group,3 cases in the experimental group,and there was significant difference between the two group（χ2=3.6027,P=0.032�

关 键 词：全身麻醉 硬膜外麻醉 肝癌 心肺功能 

分 类 号：R563.1[医药卫生—呼吸系统]