麻醉方式对上腹部手术后下呼吸道感染的影响  

Clinical study on different methods of anesthesia and their effects on lower respiratory tract infections after upper abdominal surgery

作　　者：徐忠厚 张蓉 汪静娴 叶奎 XU Zhong-hou;ZHANG Rong;WANG Jing-xian;YE Kui(Luan Hospital,Anhui Medial University,Luan 237005,Anhui,China)

机构地区：[1]安徽医科大学附属六安医院麻醉科,安徽六安237005

出　　处：《中国病原生物学杂志》2020年第3期343-345,350,共4页Journal of Pathogen Biology

摘　　要：目的研究不同麻醉方式对上腹部手术后下呼吸道感染的影响.方法选取择期上腹部手术患者150例,随机分为静脉麻醉组50例、吸入麻醉组50例、硬膜外阻滞复合全麻组50例。采集患者痰液标本进行培养,分析感染病原菌种类;收集患者相关临床资料,分析其对术后下呼吸道感染的影响。结果对患者的苏醒时间、自主呼吸恢复时间、拔管时间进行组间两两比较,静脉麻醉组与吸入麻醉组间差异无统计学意义(均P>0.05);硬膜外阻滞复合全麻组分别与另外两组比较差异均有统计学意义(均P<0.05)。术后发生下呼吸道感染静脉麻醉组为12例(24.00%),吸入麻醉组为17例(34.00%),硬膜外阻滞复合全麻组3例(6.00%)。静脉麻醉组与吸入麻醉组比较差异无统计学意义(P>0.05);硬膜外阻滞复合全麻组分别与另外两组比较差异均有统计学意义(均P<0.05)。术后30例感染者痰培养检出革兰阴性菌铜绿假单胞菌、大肠埃希菌分别为12株和7株,占分离菌的67.86%;培养出革兰阳性菌金黄色葡萄球菌、溶血性葡萄球菌、肺炎链球菌分别为5、2、2株,占32.14%。结论硬膜外阻滞复合全麻下行上腹部手术后恢复较快,下呼吸道感染率低,该麻醉方式可在上腹部手术中推广使用。感染菌以革兰阴性菌多见,应选择敏感药物进行治疗。Objective To study the effects of different methods of anesthesia on lower respiratory tract infections after upper abdominal surgery.Methods A total of 150 patients who underwent elective upper abdominal surgery were randomly divided into an Intravenous anesthesia group(50 patients),an Inhalation anesthesia group(50 patients),and an EWTBZpidural block combined with general anesthesia group(50 patients).Sputum samples were collected for culture,and pathogen types were analyzed.Clinical data on patients were collected to analyze the effects of the method of anesthesia on postoperative lower respiratory tract infections.Results Pairwise comparisons of the groups were made with regard to patients’waking time,spontaneous breathing recovery time,and extubation time.The three times did not differ significantly between the Intravenous anesthesia group and the Inhalation anesthesia group(t=-1.738,1.508,and 0.047,P>0.05).The three times did differ significantly between the Intravenous anesthesia group and the Epidural block combined with general anesthesia group(t=8.593,14.582,12.924,P<0.05).The three times differed significantly between the Inhalation anesthesia group and the Epidural anesthesia group(t=10.993,12.334,and 16.446,P<0.05).A postoperative lower respiratory tract infection developed in 12 patients(24.00%)in the Intravenous anesthesia group,17 patients(34.00%)in the Inhalation anesthesia group,and 3 patients(6.00%)in the Epidural block combined with general anesthesia group.The rate of development of a lower respiratory tract infection did not differ significantly between the Intravenous anesthesia group and the Inhalation anesthesia group(X^2=1.214,P>0.05).The rate of development of a lower respiratory tract infection differed significantly between the Intravenous anesthesia group and the Epidural block combined with general anesthesia group(X^2=6.353,P<0.05).The rate of development of a lower respiratory tract infection differed significantly between the Inhalation anesthesia group and the Epidural block c

关 键 词：上腹部手术 硬膜外阻滞复合全麻 下呼吸道感染 临床研究 

分 类 号：R378[医药卫生—病原生物学]