3种麻醉方案对上腹部手术患者术后肺部感染及免疫抑制情况研究

目的探讨不同麻醉方案对择期行上腹部手术患者术后肺部感染的影响.方法选取择期行上腹部开放手术的患者90例,随机分为静脉麻醉组、吸入麻醉组、硬膜外阻滞复合全麻组,每组各30例.观察3组患者术后肺部感染情况、苏醒时间和拔管时间;荧光免疫流式细胞术检测麻醉前和术后6,24,72 h的T淋巴细胞亚群数量,计算CD4~+/CD8~+比值.结果硬膜外阻滞复合全麻组麻醉苏醒时间和拔管时间明显短于静脉麻醉组和吸入麻醉组,差异具有统计学意义(P0.05).硬膜外阻滞复合全麻组术后感染率明显低于静脉麻醉组和吸入麻醉组,差异具有统计学意义(P0.05).麻醉前3组患者中性粒细胞计数、T淋巴细胞亚群、Th1/Th2之间差异均无统计学意义(P0.05).术后6,24,72 h 3组患者CD4~+、CD4~+/CD8~+、Th1/Th2较麻醉前均明显降低,中性粒细胞计数较麻醉前明显升高,差异具有统计学意义(P0.05);硬膜外阻滞复合全麻组患者CD4~+,CD4~+/CD8~+,Th1/Th2术后72 h内下降幅度明显小于静脉麻醉组和吸入麻醉组,中性粒细胞计数上升幅度明显小于静脉麻醉组和吸入麻醉组,差异均具有统计学意义(P0.05).结论硬膜外阻滞复合全麻免疫抑制程度较低,有利于上腹部手术患者术后早期拔管,进而降低肺部感染风险.

Application of Three Anesthetic Schemes in the Pulmonary Infection and Immunosuppression in Patients Undergoing Upper Abdominal Surgery

Objective To investigate the effect of different anesthetic methods on postoperative pulmonary infection in patients undergoing elective upper abdominal surgery. Method 90 patients undergoing elective open abdominal surgery were randomly divided into intravenous anesthesia group, inhalation anesthesia group, epidural block combined with general anesthesia group,30 cases in each group. The postoperative pulmonary infection,recovery time and extubation time of patients in the three groups were observed. The number of T lymphocyte subsets of 6 h,24 h and 72 h before and after the operation was detected by fluorescence immuno flow cytometry,and the CD4+/CD8+ ratio was calculated. Results The recovery time and extubation time of epidural block combined with general anesthesia group were significantly shorter than those of intravenous anesthesia group and inhalation anesthesia group,showing a statistically significant difference (P<0. 05). The postoperative infection rate of epidural blockade combined with general anesthesia group was significantly lower than that of intravenous anesthesia group and inhalation anesthesia group,with a statistically significant difference (P<0. 05). There was no significant difference in the neutrophil count,T lymphocyte subsets and Th1/Th2 (P>0. 05) among the three groups before anesthesia. At 6 h,24 h and 72 h after operation,CD4+/CD8+,CD4+and Th1/Th2 of patients in the three groups with were significantly lower than those before anesthesia,and the neutrophil count was significantly higher than that before anesthesia,showing a statistically significant difference (P<0. 05);The decrease amplitude of CD4+,CD4+/CD8+,Th1/Th272h after operation in patients in the epidural anesthesia group was significantly less than those in the intravenous anesthesia group and inhalation anesthesia group, and the neutrophil count increase amplitude was significantly less than that of the intravenous anesthesia and inhalation anesthesia groups, with statistically significant differences (P<0. 05). Conclusion Epidural block combined with general anesthesia has a low degree of immunosuppression, which is beneficial to early extubation and lower risk of pulmonary infection in patients undergoing upper abdominal surgery.