麻醉方式对老年下肢骨折患者术后肺部感染的影响及TLR4/NF-κB信号通路的预测价值  

Impact of anesthesia approach on postoperative pulmonary infection of elderly patients with lower extremity fracture and predictive values of TLR4/NF-κB signaling pathways

作　　者：毕路甲[1] 朱建业 陈辉[1] BI Lu-jia;ZHU Jian-ye;CHEN Hui(The Second Affiliated Hospital of Luohe Medical College,Luohe,Henan 46230O,China)

机构地区：[1]漯河医学高等专科学校第二附属医院麻醉科,河南漯河462300

出　　处：《中华医院感染学杂志》2024年第17期2646-2650,共5页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200882)。

摘　　要：目的探讨全身麻醉及腰硬联合麻醉对老年下肢骨折患者术后肺部感染的影响,并分析Toll样受体4(TLR4)/核因子-κB(NF-κB)信号通路对肺部感染的预测价值。方法本研究纳入2021年8月-2022年8月漯河医学高等专科学校第二附属医院收治的行下肢手术的老年骨折患者197例,根据手术麻醉方式的选择将所有患者分为对照组76例及研究组121例。对照组患者采用全身麻醉,研究组患者采用腰硬联合麻醉。观察两组患者手术情况、呼吸功能相关指标及术后肺部感染情况,检测外周血TLR4 mRNA及NF-κB mRNA水平。结果两组患者手术时间及出血量相比,差异均无统计学意义;手术后,与对照组相比,研究组患者SpO_(2)及MV下降幅度较小(P<0.05),RR升高幅度也较小(P<0.05);两组肺部感染发生率比较差异无统计学意义;与肺部感染组患者相比,未感染组患者外周血TLR4 mRNA及NF-κB mRNA水平均降低(P<0.05);TLR4及NF-κB联合检测预测老年下肢骨折患者术后肺部感染的曲线下面积为0.963(95%CI:0.931~0.995),敏感度为85.56%,特异性为93.58%。结论选择腰硬联合麻醉的老年下肢骨折患者发生术后肺部感染的风险更低,TLR4联合NF-κB检测在老年下肢骨折患者术后肺部感染中具有较为理想的预测价值。OBJECTIVE To explore the impact of general anesthesia and combined spinal and epidural anesthesia on postoperative pulmonary infection in the elderly patients with lower extremity fracture and analyze the values of Toll-like receptor 4(TLR4)/nuclear factor--κB(NF-κB)signaling pathways in prediction of pulmonary infection.METHODS A total of 197 elderly patients with lower extremity who received surgical procedures in the Second Affiliated Hospital of Luohe Medical College from Aug 2021 to Aug 2022 were enrolled in the study and were divided into the control group with 76 cases and the study group with 121 cases according to the anesthesia approach.The control group was adopted with general anesthesia,and the study group was given the combined spinal and epidural anesthesia.The surgical indexes,respiratory function indexes and incidence of postoperative pulmonary infection were observed and compared between the two groups of patients,and the levels of peripheral blood TLR4 mRNA and NF-κB mRNA were detected.RESULTS There were no significant differences in the operation duration and bleeding volume between the two groups of patients.SpO2 and MV of the study group declined less significantly than those of the control group after the surgery(P<0.05),while RR was elevated less significantly(P<0.05).There was no significant difference in the incidence of pulmonary infection between the two groups;the levels of peripheral blood TLR4 mRNA and NF-κB mRNA of the no infection group were lower than those of the pulmonary infection group(P<0.05).The area under curve(AUC)of the joint detection of TLR4 and NF-κB was 0.963(95%CI:0.931-0.995)in prediction of the postoperative pulmonary infection in the elderly patients with lower extremity facture,with the sensitivity 85.56%,the specificity 93.58%.CONCLUSION The elderly patients with lower extremity fracture who choose the combined spinal and epidural anesthesia are at lower risk of postoperative pulmonary infection.The joint detection of TLR4 and NF-κB has high value in pred

关 键 词：老年患者 下肢骨折 麻醉方式 肺部感染 术后感染 Toll样受体4/核因子-κB 全身麻醉 腰硬联合麻醉 

分 类 号：R683.42[医药卫生—骨科学]