食管癌患者术后肺部感染的围术期影响因素分析

发布时间：2018-03-14 04:26

本文选题：麻醉因素　切入点：肺部感染　出处：《临床麻醉学杂志》2017年06期 　论文类型：期刊论文

【摘要】：目的探讨围术期相关因素对食管癌患者术后肺部感染的影响。方法回顾性分析2012年8月至2016年8月于我院行食管癌根治术患者的临床资料,150例符合入选标准,根据术后是否并发肺部感染分为肺部感染组(n=32)与非感染组(n=118)。记录两组麻醉药物使用总量,记录两组插管时间、单肺通气时间、手术时间、全麻时间、拔管时间、术中出血量、晶体补充量、胶体补充量、术中总补液量、麻醉方法和单肺通气方式,比较两组非间断膨肺比例、鼻导管吸痰比例和术后哌替啶镇痛比例。通过Logistic回归分析预测肺部感染发生的危险因素。结果肺部感染组舒芬太尼与丙泊酚用量明显多于,单肺通气时间、手术时间、全麻时间、拔管时间明显长于,非间断膨肺比例、鼻导管吸痰比例和术后哌替啶镇痛比例明显高于非感染组(P0.05);两组咪达唑仑与顺阿曲库铵用量、插管时间、术中出血量、晶体补充量、胶体补充量、术中总补液量、麻醉方法及单肺通气方式差异均无统计学意义。Logistic回归分析显示,舒芬太尼用量每增加7.5μg(OR=1.65,95%CI 1.24~2.85)、单肺通气时间每增加10 min(OR=2.14,95%CI 1.32~3.62)、全麻时间每增加20 min(OR=1.87,95%CI 1.46~3.15)、鼻导管吸痰(OR=2.03,95%CI 1.27~3.46)及术后哌替啶镇痛(OR=3.44,95%CI 2.25~5.13)是预测术后肺部感染发生的危险因素。结论麻醉中使用合适的舒芬太尼总量、减少单肺通气时间与全麻时间、应用纤维支气管镜吸痰及术后采取自控静脉镇痛,有利于减少食管癌患者术后肺部感染的发生。
[Abstract]:Objective to investigate the effect of perioperative factors on postoperative pulmonary infection in patients with esophageal cancer. Methods the clinical data of 150 patients undergoing radical resection of esophageal cancer from August 2012 to August 2016 were analyzed retrospectively. According to the postoperative complications of pulmonary infection, they were divided into two groups: pulmonary infection group (n = 32) and non-infection group (n = 118). The total amount of anesthesia used in the two groups was recorded, the time of intubation, the time of single lung ventilation, the time of operation, the time of general anesthesia, the time of extubation and the amount of blood lost during operation were recorded. Lens supplement, colloid supplement, intraoperative fluid resuscitation, anesthesia and single lung ventilation were compared between the two groups. The risk factors of pulmonary infection were predicted by Logistic regression analysis. Results the dosage of sufentanil and propofol in pulmonary infection group was significantly higher than that in single lung ventilation time and operation time. The time of general anesthesia and extubation was longer than that of the control group, the proportion of uninterrupted pulmonary expansion, the proportion of aspiration of sputum by nasal catheter and the rate of pethidine analgesia after operation were significantly higher than those of the non-infected group (P 0.05), the dosage of midazolam and cisatracurium, the time of intubation, the amount of blood lost during operation, There was no significant difference in lens supplement, colloid supplement, total fluid rehydration during operation, anesthesia method and single lung ventilation. Logistic regression analysis showed that there was no significant difference between the two groups. The dosage of sufentanil was increased by 7.5 渭 g ORL 1.6595 CI 1.242.85, the time of single lung ventilation was increased by 10 min, the duration of general anesthesia was increased 20 min by 1.895 CI 1.463.15, the nasal catheter inhaled sputum was 2.039595 CI 1.273.46) and the postoperative pethidine analgesia OR3.44 95CI 2.255.13) were the risk factors for predicting postoperative pulmonary infection. Use the appropriate amount of sufentanil while drunk, Reducing the time of single lung ventilation and general anesthesia, using bronchofiberscope to suck sputum and postoperative patient-controlled intravenous analgesia is helpful to reduce the incidence of postoperative pulmonary infection in patients with esophageal cancer.
【作者单位】：安徽省安庆市第一人民医院麻醉科;
【分类号】：R614;R735.1

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