CAJ | 학술논문

目的：分析不同的麻醉方式对老年上腹部手术患者肺部感染的影响，为临床提供有效数据，探讨出一种比较安全、有效的麻醉方法，从而降低肺部感染发生率。方法选择2009年6月－2013年6月老年上腹部手术患者96例为研究对象，随机分为全麻复合硬膜外阻滞组（A组）、吸入麻醉组（B组）、全凭静脉全身麻醉组（C组），每组各32例，比较各组间的各项指标差异，采用SPSS15．0进行统计分析。结果 A组患者术后肺部感染率、苏醒时间及拔管时间分别为3．00％、（6．42 ± 3．29）min、（12．26 ± 6．38）min ，B组患者分别为21．88％、（15．16±8．07）min、（22．45±10．23）min ，C组患者分别为18．75％、（15．75 ± 6．67）min、（22．09±10．34）min ，其中，A组患者的术后肺部感染率分别低于B、C两组，差异有统计学意义（P＜0．05）；比较3组患者在术后6h、1d、3d的白细胞介素‐6（IL‐6）、白细胞介素‐8（IL‐8）及T淋巴细胞亚群CD4＋／CD8＋比值：3组的IL‐6和IL‐8均比麻醉前有显著提高（P＜0．05）。结论采用硬膜外阻滞复合全麻有利于早期拔管，术后肺部感染率较低，有利于老年患者病情的恢复和缩短住院天数。
목적：분석불동적마취방식대노년상복부수술환자폐부감염적영향，위림상제공유효수거，탐토출일충비교안전、유효적마취방법，종이강저폐부감염발생솔。방법선택2009년6월－2013년6월노년상복부수술환자96례위연구대상，수궤분위전마복합경막외조체조（A조）、흡입마취조（B조）、전빙정맥전신마취조（C조），매조각32례，비교각조간적각항지표차이，채용SPSS15．0진행통계분석。결과 A조환자술후폐부감염솔、소성시간급발관시간분별위3．00％、（6．42 ± 3．29）min、（12．26 ± 6．38）min ，B조환자분별위21．88％、（15．16±8．07）min、（22．45±10．23）min ，C조환자분별위18．75％、（15．75 ± 6．67）min、（22．09±10．34）min ，기중，A조환자적술후폐부감염솔분별저우B、C량조，차이유통계학의의（P＜0．05）；비교3조환자재술후6h、1d、3d적백세포개소‐6（IL‐6）、백세포개소‐8（IL‐8）급T림파세포아군CD4＋／CD8＋비치：3조적IL‐6화IL‐8균비마취전유현저제고（P＜0．05）。결론채용경막외조체복합전마유리우조기발관，술후폐부감염솔교저，유리우노년환자병정적회복화축단주원천수。
OBJECTIVE To analyze the effects of different anesthetic methods on pulmonary infection in elderly patients with abdominal surgery ,so as to explore a relatively safe and effective anesthesia method to reduce the in‐cidence of lung infections .METHODS From Jun .2009 to Jun 2013 ,a total of 96 cases of elderly patients with up‐per abdominal surgery were chosen as study objects .They were randomly divided into general anesthesia combined with epidural block group (group A) ,inhalation anesthesia group (group B) and total intravenous anesthesia group (group C) with 32 cases each .The indexes among the groups were compared and analyzed by SPSS15 .0 software .RESULTS The pulmonary infection rate ,the recovery time and extubation time were 3% ,(6 .42 ± 3 .29) min ,and (12 .26 ± 6 .38) min respectively in group A ,and they were 21 .88% ,(15 .16 ± 8 .07) min ,(22 .45 ± 10 .23) min in group B ,while in C group ,the figures were 18 .75% ,(15 .75 ± 6 .67) min ,(22 .09 ± 10 .34) min .The postoperative pulmonary infection rate in group A was less than that in group B and C .The difference was significant (P<0 .05) .The level of interleukin ‐6 (IL‐6) ,interleukin‐8 (IL‐8) and T lymphocyte subsets CD4 + /CD8 + ratio were compared in the 6h ,1d and 3d after the surgery of the three groups .The results showed that IL‐6 and IL‐8 level were increased remarkably in the three groups compared with the level before anesthesia treatments (P<0 .05) .CONCLUSION Though the comparison and analysis we can know that epidural block com‐bined with general anesthesia is in favor of early extubation and has low pulmonary infection rate after the surgery . Hence it is useful to stabilize and recover the condition of elderly patients .