不同麻醉方式对上腹部手术老年患者肺功能指标与炎症因子及T淋巴细胞亚群的影响

发布时间：2018-05-14 17:48

本文选题：老年患者 + 上腹部手术麻醉　；参考：《中华医院感染学杂志》2017年17期

【摘要】：目的探讨行上腹部手术的老年患者在接受不同麻醉方式后,对其肺部感染、炎症因子以及T淋巴细胞亚群的影响。方法选取2015年1月-2016年11月于医院行上腹部手术的老年患者100例为研究对象,按照不同的麻醉方式分为全凭静脉全身麻醉组(A组)32例、硬膜外阻滞复合静脉麻醉组(B组)33例、吸入麻醉组(C组)35例,对比患者麻醉前后的呼吸功能相关指标、恢复自主呼吸时间、睁眼及拔管时间,同时比较患者在术后肺部感染症状和感染发生率、以及在术后6、24、72h的炎症因子(IL-1β、IL-4、IL-6、IL-8)和T淋巴细胞亚群(CD_3~+、CD_4~+、CD_8~+)的水平变化。结果 B组患者呼吸功能的各项指标、恢复自主呼吸时间、自主睁眼时间和拔管时间均比A、C两组优越(P均0.05);B组患者的肺部感染症状发生情况和感染率均低于A组和C组(P均0.05);术后6、24、72h检测三组的IL-1β、IL-4、IL-6、IL-8和CD_3~+、CD_4~+、CD_8~+浓度水平存在明显差异(P均0.05)。结论老年患者行上腹部手术采取全身麻醉复合神经阻滞的麻醉方式,有利于患者尽早恢复呼吸、降低术后肺感染的发生率,患者的炎症反应较轻,对T淋巴细胞亚群浓度能够有效维持平衡,是老年患者上腹部手术比较理想的麻醉方式。
[Abstract]:Objective to investigate the effects of different anesthesia methods on pulmonary infection, inflammatory factors and T lymphocyte subsets in elderly patients undergoing epigastric surgery. Methods 100 elderly patients undergoing upper abdominal surgery in hospital from January 2015 to November 2016 were divided into two groups according to different anesthetic methods: total intravenous anesthesia group (group A, n = 32) and epidural block group (group B, n = 33). There were 35 patients in group C of inhaled anesthesia. The respiratory function, the time of spontaneous respiration, the time of opening eyes and extubation were compared before and after anesthesia, and the symptoms of pulmonary infection and the incidence of infection after operation were compared. The levels of inflammatory factor IL-1 尾, IL-4, IL-6, IL-8) and T lymphocyte subsets (CD3 ~ + CD4 ~ + CD8) were also measured at 24 h after operation. Results in group B, the indexes of respiratory function and the time of spontaneous respiration were recovered. The time of spontaneous eye opening and extubation was better than that of group A C (P < 0.05). The incidence and infection rate of pulmonary infection in group B were lower than those in group A and group C (P < 0.05), and the levels of IL-1 尾 -IL-4, IL-4IL-6, IL-6, IL-8 and CD3 ~ CD4CD8 ~ + in group B were significantly higher than those in group A and C at 62472 h postoperatively (P < 0.05). Conclusion the general anesthesia combined with nerve block for the elderly patients undergoing upper abdominal surgery is beneficial to the early recovery of respiration and the reduction of the incidence of postoperative pulmonary infection. The inflammatory reaction of the elderly patients is mild. The concentration of T lymphocyte subsets can maintain balance effectively and is an ideal anaesthesia for upper abdominal surgery in elderly patients.
【作者单位】：淄博市中心医院麻醉科;
【分类号】：R614

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