文章摘要
金胜,余正文,黄少军.腰麻-硬膜外联合麻醉对老年开腹手术患者认知障碍及肺部感染的影响[J].中国临床保健杂志,2018,21(1):44-47.
腰麻-硬膜外联合麻醉对老年开腹手术患者认知障碍及肺部感染的影响
Effect of combined spinal and epidural anesthesia on cognitive impairment and pulmonary infection in elderly patients with laparotomy
投稿时间:2017-01-04  
DOI:10.3969/J.issn.1672-6790.2018.01.013
中文关键词: 麻醉/副作用  认知障碍  呼吸道感染  老年人
英文关键词: Anesthesia/adverse  Cognition disorders  Respiratory tract infections  Aged〖FL
基金项目:湖北省自然科学基金项目(ZRY1150)
作者单位E-mail
金胜 湖北襄阳市中心医院麻醉科,441021 js1135738@163.com 
余正文 湖北襄阳市中心医院麻醉科,441021 yzwonline@sina.com 
黄少军 湖北襄阳市中心医院麻醉科,441021  
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中文摘要:
      目的 探讨腰麻-硬膜外联合麻醉对老年开腹手术患者认知功能障碍、肺部感染的影响。方法选取接受开腹手术治疗的160例老年患者进行回顾性分析,其中80例采取腰麻-硬膜外联合麻醉(A组)、80例采取全身麻醉(B组),对比两组患者术后短期认知功能、肺部感染的发生率。结果 麻醉前,A、B两组患者的心率(HR)、平均动脉压(MAP)、动脉血氧饱和度(SpO2)水平差异均无统计学意义(P>0.05);手术10 min、术后5 min,A组的HR、MAP均低于B组(P<0.05);两组患者的SpO2水平在各个时刻比较,差异无统计学意义(P>0.05);手术后24 h,A组患者的简明精神状态量表评分高于B组(P<0.05);手术后24 h,A组患者的术后认知功能障碍(POCD)发生率11.25%低于B组的26.25%(P<0.05);术后24 h、术后72 h,B组的白细胞介素-6(IL-6)、白细胞介素-8(IL-8)高于A组(P<0.05);术后24 h,B组的CD4+/CD8+水平低于A组(P<0.05);手术后7 d内,A组肺部感染发生率6.25%(5/80)低于B组患者的16.25%(13/80),差异有统计学意义(χ2=4.006,P=0.045)。结论 腰麻-硬膜外联合麻醉对老年开腹手术患者认知功能影响较小、肺部感染发生率较低,但是对患者的血流动力学影响较大。
英文摘要:
      Objective To explore the effect of combined spinal and epidural anesthesia on cognitive impairment and pulmonary infection in elderly patients with laparotomy.Methods One hundred and sixty elderly patients with laparotomy were retrospectively analyzed,including 80 cases with combined spinal epidural anesthesia (A group),80 cases of general anesthesia (B group).The postoperative short-term cognitive function,incidence of lung infection were compared between two groups.Results No significance differences were observed at HR,MAP and SpO2 between the two groups (P>0.05).10 min,5 min after surgery,HR and MAP within 10 minutes and 5 min postoperatively of A group were lower than those in group B (P<0.05);there was no statistical difference in SpO2 of each time between two groups(P>0.05).The group A had a higher level of MMSE and lower incidence of POCD(11.25%) compared with group B(26.25%)(P<0.05).IL-6 and IL-8 of B group was higher than those in group A at 24h,72h postoperatively (P<0.05).The levels of CD4+/CD8+ of group B was lower than that in A group (P<0.05) within 24h postoperatively.The incidence of pulmonary infection of group A(6.25%) was lower than that in B group(16.25%),the difference was statistically significant (χ2=4.006,P=0.045).Conclusion Combined spinal and epidural anesthesia has a smaller effect on the cognitive function of elderly patients with laparotomy,and the incidence of pulmonary infection is low,but it has an apparent influence on the hemodynamics of the patients.
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