麻醉方式对胃癌患者术后呼吸道感染及T淋巴细胞和应激水平的影响

发布时间：2018-02-14 18:53

本文关键词： 胃癌患者麻醉方式呼吸道感染 T淋巴细胞应激状态　出处：《中华医院感染学杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的探讨麻醉方式对胃癌患者术后呼吸道感染及T淋巴细胞、应激水平的影响,以期为降低胃癌患者术后呼吸道感染提供依据。方法收集2013年1月-2016年5月医院手术治疗的胃癌患者105例,分为观察组与对照组,观察组53例给予静脉全麻复合硬膜外麻醉联合术后硬膜外镇痛,对照组52例给予全凭静脉麻醉复合术后伤口镇痛,观察两组患者术后感染率,麻醉前、麻醉后不同时间T淋巴细胞及免疫应激指标变化。结果术后7d内,观察组患者感染率3.77%低于对照组21.15%,差异有统计学意义(P0.05);观察组麻醉前及术后不同时间点T淋巴细胞指标及应激指标去甲肾上腺素对比,差异均无统计学意义;观察组患者术后不同时间血糖值与麻醉前对比,差异均有统计学意义(P0.05),皮质醇、肾上腺素术后72h高于麻醉前低于对照组同期,差异有统计学意义(P0.05);对照组术毕CD3+、CD4+均低于麻醉前同指标,差异有统计学意义(P0.05),术后72h CD8+、CD4+/CD8+比值均低于麻醉前同指标,差异有统计学意义(P0.05),应激指标术后不同时间点均高于麻醉前同指标,差异有统计学意义(P0.05)。结论胃癌患者给予静脉全麻复合硬膜外麻醉联合术后硬膜外镇痛对术后呼吸道感染具有一定影响,且对T淋巴细胞干扰较小、对抗应激状态明显,有可能起到降低术后感染的作用。
[Abstract]:Objective to investigate the effect of anesthesia on postoperative respiratory tract infection, T lymphocyte and stress level in patients with gastric cancer. Methods from January 2013 to May 2016, 105 patients with gastric cancer were divided into observation group and control group. 53 cases in the observation group were given general intravenous anesthesia combined with epidural anesthesia combined with postoperative epidural analgesia, and 52 cases in the control group were given total intravenous anesthesia combined with postoperative wound analgesia. Results the changes of T lymphocytes and immune stress indexes were observed within 7 days after anesthesia. The infection rate of patients in the observation group was 3.77% lower than that in the control group (21.15), the difference was statistically significant (P 0.05), and there was no significant difference in T lymphocyte index and norepinephrine between the observation group and the control group at different time points before and after anesthesia. In the observation group, the blood glucose values at different time after anesthesia were significantly different from those before anesthesia. The levels of cortisol and epinephrine at 72 hours after operation were higher than those before anesthesia and were lower than those in the control group at the same time. The difference was statistically significant (P 0.05), and that of the control group after operation was lower than that before anesthesia, and the difference was statistically significant (P 0.05). At 72 hours after operation, the ratio of CD8 CD4 / CD8 was lower than that before anesthesia. The difference was statistically significant (P 0.05). Stress indexes were higher than those before anesthesia at different time points after operation. Conclusion intravenous general anesthesia combined with epidural anesthesia combined with postoperative epidural analgesia has a certain effect on postoperative respiratory tract infection, and it has little interference on T lymphocytes and obvious anti-stress state. It may play a role in reducing postoperative infection.
【作者单位】：成都市第七人民医院麻醉科;攀枝花市攀钢总医院麻醉科;
【基金】：四川省科技厅科技支撑计划(2013FZ2329)
【分类号】：R614;R735.2

【相似文献】