摘要
目的探讨不同麻醉方法对老年食管癌患者术后肺部感染的影响,为预防肺部感染提供参考。方法选择140例择期老年食管癌手术患者,随机分为胸段硬膜外阻滞复合静脉全麻+术后自控硬膜外镇痛组(A组)和全凭静脉麻醉+术后自控静脉镇痛(B组),每组各70例;两组患者分别在麻醉前、拔管后5min 2个时相监测呼吸功能变化:呼吸频率(RR)、血氧饱和度(SpO2)、分钟通气量(MV);术毕停药后观察两组患者自主呼吸恢复时间、呼之睁眼时间、拔管时间,并于术后第3天监测两组患者有无发热、咳嗽咳痰、肺部啰音、白细胞>15×109/L,检查胸部X线片,比较两组患者肺部感染的发生率。结果 B组患者拔管后RR、MV、SpO2较麻醉前有较显著的变化(P<0.05),而A组变化不大,两组拔管后RR、MV、SpO2比较,差异有统计学意义(P<0.05);术毕停药后观察A组患者自主呼吸恢复时间、呼之睁眼时间、拔管时间均明显短于B组患者(P<0.05);术后第3天监测结果显示,观察组出现发热(>38℃)、咳嗽咳痰、肺部啰音、白细胞>15×109/L、胸片见炎症改变及肺部感染发生率,均明显低于对照组(P<0.05)。结论胸段硬膜外阻滞复合静脉全麻加自控硬膜外镇痛更加有利于老年食管癌患者术后的呼吸功能恢复,可有效地预防术后肺部感染。
OBJECTIVE To investigate the effects of different anesthesia methods on postoperative pulmonary infections in the elderly patients with esophagus cancer so as to provide basis for the prevention of pulmonary infections. METHODS A total of 140 elderly patients who underwent the selective lobectomy for esophagus cancer were randomly divided into two groups with 70 cases in each.In the group A,the patients received general anesthesia combined with thoracic epidural anesthesia during surgery and received epidural analgesia;the patients in the group B received general anesthesia and intravenous analgesia postoperatively.The respiratory function（RR,MV,SpO2）were obtained at the following time points：before the induction of anesthesia,5 min after the extubation.The time of breathing,opening eyes,and extubation were monitored in the two groups.On the third after the surgery,the fever,productive cough,pulmonary rale,white blood cell count（〉15×10^9/L）,and chest X-ray were monitored,and the incidence of the pulmonary infections were compared between the two groups.RESULTS There was significant difference in the RR,MV or SpO2 of the group B between before the induction of anesthesia and 5 min after extubation（P〈0.05）,while there was significant difference in the group A,but the difference in the RR,MV or SpO2 after the extubation between the group A and the group B was statistically significant（P〈0.05）;after the withdraw of drugs,the time of breathing,opening eyes,or extubation was significantly shorter in the group A than in the group B（P〈0.05）.The monitoring result on the third day after the surgery indicated that the incidence rate of the fever（higher than 38℃）,productive cough,pulmonary rale,white blood cell count（higher than 15×10^9/L）,inflammation captured by the chest X-ray,or pulmonary infections was significantly lower in the observation group than in the control group（P〈0.05）.CONCLUSION General anesthesia combined with thoraeic epidural anesthesia may benefit the recovery of respiratory function of the elderly patients undergoing lobectomy for esophagus cancer,effectively preventing the postoperative pulmonary infections.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第10期2337-2339,共3页
Chinese Journal of Nosocomiology
关键词
胸部硬膜外麻醉
全凭静脉麻醉
食管癌
肺部感染
Thoracic epidural anesthesia
General anesthesia
Esophagus cancer
Pulmonary infection
