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目的探讨不同麻醉方式下行腹部良性肿瘤切除术老年患者术后肺部感染情况。方法择期行腹部良性肿瘤切除术老年患者45例,其中20例采用全凭静脉麻醉(全凭静脉麻醉组),25例采用硬脊膜外阻滞复合全身麻醉(硬脊膜外麻醉组),分别于麻醉前、术后6、24、72h检测2组白细胞介素(interleukin,IL)-6、IL-8、CD4~+/CD8~+水平,比较2组术后14d内肺部感染发生率。结果术后14d内,全凭静脉麻醉组肺部感染率(20.0%)高于硬脊膜外麻醉组(4.0%)(P<0.05);术后6、24h,全凭静脉麻醉组IL-6[(34.23±5.11)、(33.12±5.12)μg/L]、IL-8[(56.72±9.68)、(50.11±7.83)μg/L]高于麻醉前[(29.71±4.52)、(33.87±6.72)μg/L],CD4~+/CD8~+(1.58±0.22、1.51±0.18)低于麻醉前(1.63±0.23)(P<0.05);硬脊膜外麻醉组术后6hIL-6[(31.11±4.49)μg/L]、IL-8[(47.23±8.23)μg/L]高于麻醉前[(29.72±4.56)、(33.91±6.74)μg/L](P<0.05);全凭静脉麻醉组术后6、24h的IL-6、IL-8水平高于硬脊膜外麻醉组,CD4~+/CD8~+水平低于硬脊膜外麻醉组,差异均有统计学意义(P<0.05)。结论与全凭静脉麻醉相比,老年患者腹部良性肿瘤切除手术采用硬脊膜外阻滞复合全身麻醉可降低术后肺部感染发生率,对患者免疫功能影响较小。
Objective To investigate the postoperative pulmonary infection in elder patients with benign tumor resection under different anesthesia. Methods Forty-five elderly patients undergoing benign abdominal resection were enrolled in this study. Twenty patients were treated with total intravenous anesthesia (total intravenous anesthesia), 25 patients with epidural block combined with general anesthesia (epidural anesthesia) The levels of interleukin (IL) -6, IL-8 and CD4 ~ + / CD8 + in the two groups were detected before anesthesia and at 6, 24 and 72 hours after operation respectively. Pulmonary infection was compared within 14 days after operation rate. Results Within 14 days after operation, the pulmonary infection rate (20.0%) in total intravenous anesthesia group was higher than that in epidural anesthesia group (4.0%) (P <0.05). At 6 and 24 hours after operation, (34.23 ± 5.11), (33.12 ± 5.12) μg / L, IL-8 [(56.72 ± 9.68), (50.11 ± 7.83) μg / L] were significantly higher than those before anesthesia [(29.71 ± 4.52), ± 6.72) μg / L], and the levels of CD4 ~ + / CD8 ~ + (1.58 ± 0.22,1.51 ± 0.18) were lower than those before anesthesia (1.63 ± 0.23) (31.11 ± 4.49) μg / L and IL-8 [(47.23 ± 8.23) μg / L] before anesthesia [(29.72 ± 4.56) and (33.91 ± 6.74) μg / L] The levels of IL-6 and IL-8 in total intravenous anesthesia group were higher than those in epidural anesthesia group at 6 and 24 hours after operation, and the levels of CD4 ~ + / CD8 + were lower than those in epidural anesthesia group Significance (P <0.05). Conclusion Compared with total intravenous anesthesia, epidural block combined with general anesthesia in elderly patients with benign tumor resection can reduce the incidence of postoperative pulmonary infection, and have little effect on the immune function.