硬膜外阻滞复合全身麻醉对降低老年患者上腹部术后肺部感染的作用  

Value of epidural block combined with general anesthesia in reducing postoperative pulmonary infection in elderly patients undergoing upper abdominal surgery

作　　者：刘杰 陈文美 冯成 朱涛[1] 方育 Liu Jie;Chen Wenmei;Feng Cheng;Zhu Tao;Fang Yu(Department of Anesthesiology,Songjiang District Central Hospital,Shanghai 201600,China)

机构地区：[1]上海市松江区中心医院麻醉科,201600

出　　处：《中国药物与临床》2019年第9期1393-1396,共4页Chinese Remedies & Clinics

基　　金：国家自然科学基金(81660456)

摘　　要：目的评价硬膜外阻滞复合全身麻醉对降低老年患者上腹部术后肺部感染的作用,为老年患者选择安全有效的麻醉方法提供参考。方法选择我院2017年1月至12月择期行上腹部开放手术的老年患者249例,采用隐匿数字随机法分为3组,每组83例,分别采用硬膜外阻滞复合全身麻醉、静脉麻醉和吸入麻醉,比较各组患者拔管后5 min呼吸功能、麻醉恢复情况、肺部感染征象发生率;术后24 h、72 h检测白细胞介素(IL)-6、IL-8及T细胞亚群CD4+、CD8+数量,计算CD4+/CD8+比值,比较3组术后肺部感染发生情况。结果拔管后5 min复合麻醉组血氧饱和度(SpO2)、分钟通气量(MV)明显高于静脉麻醉组、吸入麻醉组,呼吸频率(R)明显低于静脉麻醉组、吸入麻醉组,差异有统计学意义(P<0.05)。复合麻醉组自主呼吸恢复时间、呼之睁眼时间和拔管时间均短于静脉麻醉组、吸入麻醉组,差异有统计学意义(P<0.05)。复合麻醉组术后3 d发热、咳嗽、肺部音、胸部X线片特征表现、白细胞计数>10×109/L发生率低于静脉麻醉组和吸入麻醉组比较差异均有统计学意义(P<0.05)。复合麻醉组术后24 h CD4+/CD8+低于术前,差异有统计学意义(P<0.05)。复合麻醉组术后24 h、72 h IL-6、IL-8水平明显低于静脉麻醉组、吸入麻醉组,CD4+/CD8+明显高于静脉麻醉组、吸入麻醉组,差异均有统计学意义(P<0.05)。结论老年上腹部手术患者采用硬膜外阻滞复合全身麻醉苏醒快,对呼吸功能影响小,免疫抑制程度低,可降低术后肺部感染风险。Objective To evaluate the value of epidural block combined with general anesthesia in reducing postoperative pulmonary infection in elderly patients undergoing upper abdominal surgery, and to provide evidence for the selection of safe and effective anesthesia options for elderly patients. Methods A total of 249 elderly patients who underwent open surgery to the upper abdomen between January 2017 and December 2017 in our hospital were enrolled, and by using the blinded digital randomization method, divided into three groups(n=83 each) in which epidural block plus general anesthesia, intravenous anesthesia, and inhalation anesthesia were given at surgery, re-spectively. The three groups were recorded for respiratory function at 5-min after extubation, anesthesia recovery and signs of pulmonary infections. At 24 h and 72 h after operation, the patients were examined for levels of interleukin-6(IL-6) and IL-8 as well as T lymphocyte subsets CD4^+and CD8^+. The CD4^+/CD8^+ratio was calculated accordingly. The incidence of postoperative pulmonary infections in the three groups were compared. Results At 5-min after extubation, the patients in the combination anesthesia group showed higher SpO2 and minute ventilation(MV) than those in the intravenous anesthesia group and the inhalation anesthesia group with statistically significant difference( P<0.05).The time to recovery of spontaneous breathing, time to eye opening on command, and time to extubation in the combi-nation anesthesia group were shorter than those in the intravenous anesthesia group and the inhalation anesthesia group, with statistically significant difference(P <0.05). In the combination anesthesia group, the incidence rates of fever, cough, pulmonary rales, specific chest X-ray signs, and WBC>10×10^9/L were lower than that of intravenous anesthesia group and the inhalation anesthesia group with statistically significant differences( P<0.05). The CD4+/CD8+ratio was lower than baseline at 24 h after operation in the combination anesthesia group(P<0.05). T

关 键 词：麻醉 硬膜外 麻醉药 全身 老年人 感染 上腹部手术 

分 类 号：R614[医药卫生—麻醉学]