摘要
目的分析腰硬联合麻醉与全身麻醉对老年开腹手术患者效果及术后肺部感染影响。方法选自医院2015年6月-2016年12月期间行开腹手术患者182例,按照麻醉方法不同分为腰硬联合麻醉组与全身麻醉组,各91例,比较两组手术前后平均动脉压、心率、应激反应变化,术前、术后1d、术后3d简易智力状态评分(MMSE),及术后3d肺部感染情况。结果腰硬联合麻醉组术后平均动脉压和心率分别为(97.67±6.87)mmHg和(79.28±4.09)次/min低于全身麻醉组(113.24±8.49)mmHg和(103.37±6.26)次/min(P<0.001);术后腰硬联合麻醉组术后皮质醇(Cor)和去甲肾上腺素(NE)(340.76±63.72)ng/ml和(1.35±0.43)nmol/L低于全身麻醉组(P<0.001);腰硬联合麻醉组MMSE评分术后1d、3d分别为(25.59±3.87)、(25.87±4.18)分高于全身麻醉组(P<0.001);腰硬联合麻醉组术后3d肺部感染率4.40%低于全身麻醉组18.68%(P<0.05)。结论腰硬联合麻醉用于老年开腹手术效果优于全身麻醉,对患者应激反应和认知功能影响小,且可降低术后肺部感染。
OBJECTIVE To compare and analyze the effects of combined spinal epidural anesthesia and general anes- thesia on elderly patients with open surgery and postoperative pulmonary infections. METHODS A total of 182 pa- tients who underwent open surgery in our hospital from Jun. 2015 to Dec. 2016 were selected. According to the different methods of anesthesia, the patients were divided into combined spinal epidural anesthesia group （n = 91） and general anesthesia group （n=91）. The preoperative and postoperative mean arterial pressure, heart rate and stress response were compared between the two groups, and preoperative, postoperative ld, postoperative 3d score of MMSE, and postoperative 3d pulmonary infections were compared.RESULTS The mean arterial pressure and heart rate of combined spinal epidural anesthesia group were （97.67±6.87） mmHg and （79.28±4.09）/min, which were lower than （113.24±8.49） mmHg and （103.37±6.26）/min of general anesthesia group （P〈0.001）. The Cor and NE after operation of combined spinal epidural anesthesia group were （340.76±63.72）ng/mL and （1. 35±60.43） nmol/L, which were lower than general anesthesia group （P〈0.001）. The postoperative ld and 3d MMSE score of combined spinal epidural anesthesia group were （25.59 ± 3.87） and （25.87± 4.18） points, which were higher than general anesthesia group （P〈0.001）. The rate of postoperative 3d infection in combined spinal epidural anesthesia group after operation was 4.40%, which was lower than 18.68% of general anesthesia group （P〈0.05）.CONCLUSION The combined spinal epidural anesthesia is better than general anesthesia in elderly pa- tients. It has a significant impact on the stress response and cognitive function of patients, and can reduce postop- erative pulmonary infections.
作者
郝景宇
赵尤美
林康
盛兵兵
许建军
HAO Jing-yu;ZHAO You-mei;LIN Kang;SHENG Bing-bing;XU Jian-jun(Wenling First Peoplets Hospital, Wenling ,Zhejiang 317500, China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2018年第3期402-405,共4页
Chinese Journal of Nosocomiology
基金
浙江省医药卫生一般研究计划基金资助项目(2014KYA143)
关键词
腰硬联合麻醉
全身麻醉
老年开腹手术
效果
术后肺部感染
Combined spinal epidural anesthesia
General anesthesia
Open surgery in elderly patients
Effect
Postoperative pulmonary infection
