肺结核患者胸部手术后不同镇痛方式对术后感染的影响

发布时间：2018-03-19 09:07

本文选题：肺结核　切入点：术后感染　出处：《中华医院感染学杂志》2017年10期 　论文类型：期刊论文

【摘要】：目的探讨肺结核患者胸部手术后不同镇痛方式对术后感染的影响,为临床用药提供依据。方法选取2012年12月-2016年5月绍兴市立医院行手术治疗的肺结核患者320例,分别行胸腔镜下肺部分切除术、肺大泡切除术及脓胸切除术,所有患者采用常规硬膜外导管置入后全身麻醉,根据术后镇痛方式不同分为静脉镇痛组及硬膜外镇痛组,每组各160例;观察两组患者医院感染率及医院感染部位分布,行体液培养及病原学分析;采用荧光免疫流式细胞术,分别测定两组患者术前及镇痛后2d的T淋巴细胞亚群(CD_4~+、CD_8~+、CD_4~+/CD_8~+)的数量。结果 320例患者中发生医院感染64例,感染率为20.00%;两组患者主要感染部位为呼吸道、胃肠道、尿道、切口;共分离出病原菌64株,其中静脉镇痛组检出病原菌40株,革兰阴性菌、革兰阳性菌、真菌分别占72.50%、25.00%和2.50%;硬膜外镇痛组检出病原菌24株,革兰阴性菌、革兰阳性菌、真菌分别占66.66%、29.17%和4.17%;镇痛2d后,两组患者CD_4~+、CD_8~+、CD_4~+/CD_8~+均有所降低,其中静脉镇痛组CD_4~+、CD_8~+,硬膜外镇痛组CD_4~+与治疗前相比差异有统计学意义(P0.05),静脉镇痛组CD_4~+/CD_8~+,硬膜外镇痛组CD_8~+、CD_4~+/CD_8~+较术前出现下降,但差异无统计学意义。结论硬膜外镇痛组患者术后感染率低于静脉镇痛组患者,两组患者感染类型及病原学构成相似,镇痛2d后T淋巴细胞亚群均有所改变,但硬膜外镇痛组波动更小,其是否与术后感染相关还需进一步研究。
[Abstract]:Objective to investigate the effect of different analgesic methods on postoperative infection in patients with pulmonary tuberculosis after thoracic surgery, and to provide evidence for clinical use. Methods 320 patients with pulmonary tuberculosis undergoing surgical treatment in Shaoxing City Hospital from December 2012 to May 2016 were selected. The patients were divided into intravenous analgesia group and epidural analgesia group according to the postoperative analgesia methods. The patients were subjected to partial pneumonectomy, alveolectomy and abscess resection under thoracoscope respectively. All patients were anesthetized by routine epidural catheterization after general anesthesia, and were divided into intravenous analgesia group and epidural analgesia group. The nosocomial infection rate and nosocomial infection site distribution were observed, body fluid culture and etiological analysis were performed, and fluorescence immunoflow cytometry (FFCM) was used to analyze the nosocomial infection rate and nosocomial infection site. The number of T lymphocyte subsets (CD4 ~ CD8- / CD8 ~) of T lymphocyte subsets before operation and 2 days after analgesia in the two groups were measured. Results the nosocomial infection occurred in 64 patients (20.00%) in 320 patients, and the main sites of infection were respiratory tract, gastrointestinal tract, urethra, and urethra. In the group of intravenous analgesia, there were 40 strains of pathogenic bacteria, 40 strains of Gram-negative bacteria, gram-positive bacteria, and fungi accounted for 72.50% and 2.50%, respectively, in epidural analgesia group, 24 strains of pathogenic bacteria, 24 strains of gram-negative bacteria, and 2.50% of gram-positive bacteria were found in epidural analgesia group. After 2 days of analgesia, CD4 ~ + CD8 ~ / CD8 ~ / CD8 ~ / CD8 ~ / CD8 ~ / CD8 ~% decreased in the two groups, especially in the vein analgesia group CD4 ~ + CD4 ~ ~ ~, the epidural analgesia group in which there was a significant difference between before and after treatment (P0.05), and in the intravenous analgesia group, CD4 ~ / -CD8 ~ + -CD8 ~ / -CD8 ~ ~, there was a significant difference between the epidural analgesia group and the pre-treatment group. In epidural analgesia group, CD8 ~ / CD4 ~ / CD8-1 decreased, but the difference was not statistically significant. Conclusion the postoperative infection rate of epidural analgesia group is lower than that of intravenous analgesia group, and the infection types and etiological composition of the two groups are similar. After 2 days of analgesia, T lymphocyte subsets were all changed, but the fluctuation of epidural analgesia group was smaller, and whether it was related to postoperative infection should be further studied.
【作者单位】：绍兴市立医院麻醉科;
【基金】：浙江省医药卫生一般研究计划基金资助项目(2015KYB403)
【分类号】：R614

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