腹部手术患者不同麻醉镇痛方式对术后下呼吸道感染的影响

发布时间：2018-05-24 04:06

本文选题：腹部手术 + 下呼吸道感染　；参考：《中华医院感染学杂志》2015年12期

【摘要】：目的比较观察不同麻醉镇痛方式对腹部手术患者术后下呼吸道感染的影响,为合理选择麻醉镇痛方式提供依据。方法回顾性分析医院2010年9月-2013年3月53例采用单纯全身麻醉及术后静脉自控镇痛(A组)和67例硬膜外麻醉及术后硬膜外自控镇痛(B组),进行腹部手术患者临床资料,比较两组麻醉效果、血气分析指标及下呼吸道感染率。结果 A组下呼吸道感染率为34.0%,明显高于B组的17.9%,差异有统计学意义(P0.05);A组共分离出26株病原菌,其中革兰阴性菌19株占73.0%、革兰阳性菌7株占27.0%,B组共分离出18株病原菌,其中革兰阴性菌14株占77.8%、革兰阳性菌4株占22.2%,两组病原菌分布比较差异无统计学意义;A、B两组的麻醉优良率分别为92.5%、91.0%,两组比较差异无统计学意义;两组患者术后pH值、动脉血氧分压、动脉血二氧化碳分压、血氧饱和度水平比较差异无统计学意义。结论单纯全身麻醉及术后静脉自控镇痛和硬膜外麻醉及术后硬膜外自控镇痛,对进行腹部手术患者均是有效的麻醉镇痛方式,但后者发生下呼吸道感染的机会更低,值得临床推广应用。
[Abstract]:Objective to compare the effects of different analgesic methods on lower respiratory tract infection in patients undergoing abdominal surgery. Methods from September 2010 to March 2013, the clinical data of 53 patients undergoing abdominal surgery in our hospital were analyzed retrospectively, who were treated with simple general anesthesia and postoperative patient-controlled intravenous analgesia (group A) and 67 patients with epidural anesthesia and postoperative patient-controlled epidural analgesia (group B). Anaesthesia effect, blood gas analysis index and lower respiratory tract infection rate were compared between the two groups. Results the infection rate of lower respiratory tract in group A was 34.0, which was significantly higher than that in group B (17.9). The difference was statistically significant (P 0.05). A total of 26 pathogenic bacteria were isolated from group A, of which 19 were Gram-negative bacteria (73.0) and 7 Gram-positive bacteria (27.0%). Among them, 14 Gram-negative bacteria accounted for 77.8%, 4 Gram-positive bacteria accounted for 22.20.There was no significant difference in the distribution of pathogenic bacteria between the two groups. The excellent and good rates of anesthesia in the two groups were 92.5% and 91.0%, respectively, and there was no significant difference between the two groups. There was no significant difference in arterial partial pressure of oxygen, partial pressure of arterial blood carbon dioxide and blood oxygen saturation. Conclusion simple general anesthesia, postoperative patient-controlled intravenous analgesia and epidural analgesia and postoperative patient-controlled epidural analgesia are effective analgesic methods for patients undergoing abdominal surgery, but the incidence of lower respiratory tract infection in the latter patients is lower. It is worth popularizing and applying in clinic.
【作者单位】：南阳市中心医院麻醉科;郑州大学第二附属医院麻醉科;
【基金】：河南省自然科学基金资助项目(324410127)
【分类号】：R614

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