不同麻醉方式对腹部手术患者术后感染与免疫功能及血清IL-6和TNF-α水平的影响研究

发布时间：2018-03-18 01:30

本文选题：腹部外科手术　切入点：硬膜外阻滞　出处：《中华医院感染学杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的探讨不同麻醉方式对腹部外科手术患者术后感染与免疫功能及血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平的影响。方法 2015年10月-2016年10月选取150例腹部外科手术患者,分为吸入麻醉组50例(A组),全凭静脉麻醉组50例(B组),硬膜外阻滞复合全麻组50例(C组),比较各组患者麻醉效果、术后感染、免疫功能及血清IL-6、TNF-α水平。结果 C组患者术后感染率低于A组、B组,差异有统计学意义(P0.05),而苏醒及拔管时间短于A组、B组,差异有统计学意义(P0.05),A组、B组术后感染率、苏醒及拔管时间比较,差异无统计学意义;3组术后6h、1dCD3+、CD4+、CD4+/CD8+水平较术前低,而术后3d恢复至术前水平(P0.05),而C组术后6h、1dCD3+、CD4+、CD4+/CD8+水平高于A组、B组,而A组、B组术后6h、1d、3d CD3+、CD4+、CD4+/CD8+水平比较差异无统计学意义;C组患者术后6h、1d、血清IL-6、TNF-α水平低于A组、B组,差异有统计学意义(P0.05),而A组、B组术后6h、1d血清IL-6、TNF-α水平比较差异无统计学意义。结论硬膜外阻滞复合全麻有利于外科手术患者早期拔管,减轻患者免疫抑制,降低患者术后血清炎症因子水平,有助于降低术后感染。
[Abstract]:Objective to investigate the effects of different anesthetic methods on postoperative infection, immune function and serum levels of interleukin-6 (IL-6) and tumor necrosis factor- 伪 (TNF- 伪) in patients undergoing abdominal surgery. Methods 150 patients undergoing abdominal surgery from October 2015 to October 2016 were selected. They were divided into two groups: inhaled anesthesia group (n = 50), intravenous anesthesia group (n = 50), epidural block combined with general anesthesia group (n = 50) and group C (n = 50). Results the postoperative infection rate in group C was lower than that in group A (P 0.05), but the time of recovery and extubation was shorter than that in group B (P 0.05). There was no significant difference in the recovery and extubation time between the three groups. The level of CD 4 / CD 8 on the 1st day after operation in group C was lower than that in group B, but it recovered to the preoperative level at 3 days after operation (P 0.05), while the level of CD4 / CD 8 in group C was higher than that in group B at 6 hours after operation, and the level of CD 4 / CD 8 in group C was higher than that in group B at 6 hours after operation. However, there was no significant difference in the level of CD4 / CD8 between group A and B at 6 hours and 3 days after operation. The serum level of IL-6 TNF- 伪 in group C was lower than that in group A and B, and the level of IL-6 TNF- 伪 in group C was lower than that in group B. The difference was statistically significant (P 0.05), but there was no significant difference in serum IL-6 TNF- 伪 level between group A and group B at 6 hours after operation. Conclusion epidural block combined with general anesthesia is beneficial to the early extubation of surgical patients and reduces the immunosuppression of the patients. Reducing the level of serum inflammatory factors is helpful to reduce postoperative infection.
【作者单位】：新乡医学院第二附属医院急诊科;新乡卫生学校基护教研室;复旦大学附属肿瘤医院麻醉科;新乡医学院第二附属医院检验科;
【分类号】：R614

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