本文關(guān)鍵詞： 胃癌患者 麻醉方式 呼吸道感染 T淋巴細(xì)胞 應(yīng)激狀態(tài)　出處：《中華醫(yī)院感染學(xué)雜志》2017年03期 　論文類型：期刊論文

【摘要】：目的探討麻醉方式對胃癌患者術(shù)后呼吸道感染及T淋巴細(xì)胞、應(yīng)激水平的影響,以期為降低胃癌患者術(shù)后呼吸道感染提供依據(jù)。方法收集2013年1月-2016年5月醫(yī)院手術(shù)治療的胃癌患者105例,分為觀察組與對照組,觀察組53例給予靜脈全麻復(fù)合硬膜外麻醉聯(lián)合術(shù)后硬膜外鎮(zhèn)痛,對照組52例給予全憑靜脈麻醉復(fù)合術(shù)后傷口鎮(zhèn)痛,觀察兩組患者術(shù)后感染率,麻醉前、麻醉后不同時(shí)間T淋巴細(xì)胞及免疫應(yīng)激指標(biāo)變化。結(jié)果術(shù)后7d內(nèi),觀察組患者感染率3.77%低于對照組21.15%,差異有統(tǒng)計(jì)學(xué)意義(P0.05);觀察組麻醉前及術(shù)后不同時(shí)間點(diǎn)T淋巴細(xì)胞指標(biāo)及應(yīng)激指標(biāo)去甲腎上腺素對比,差異均無統(tǒng)計(jì)學(xué)意義;觀察組患者術(shù)后不同時(shí)間血糖值與麻醉前對比,差異均有統(tǒng)計(jì)學(xué)意義(P0.05),皮質(zhì)醇、腎上腺素術(shù)后72h高于麻醉前低于對照組同期,差異有統(tǒng)計(jì)學(xué)意義(P0.05);對照組術(shù)畢CD3+、CD4+均低于麻醉前同指標(biāo),差異有統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后72h CD8+、CD4+/CD8+比值均低于麻醉前同指標(biāo),差異有統(tǒng)計(jì)學(xué)意義(P0.05),應(yīng)激指標(biāo)術(shù)后不同時(shí)間點(diǎn)均高于麻醉前同指標(biāo),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論胃癌患者給予靜脈全麻復(fù)合硬膜外麻醉聯(lián)合術(shù)后硬膜外鎮(zhèn)痛對術(shù)后呼吸道感染具有一定影響,且對T淋巴細(xì)胞干擾較小、對抗應(yīng)激狀態(tài)明顯,有可能起到降低術(shù)后感染的作用。
[Abstract]:Objective to investigate the effect of anesthesia on postoperative respiratory tract infection, T lymphocyte and stress level in patients with gastric cancer. Methods from January 2013 to May 2016, 105 patients with gastric cancer were divided into observation group and control group. 53 cases in the observation group were given general intravenous anesthesia combined with epidural anesthesia combined with postoperative epidural analgesia, and 52 cases in the control group were given total intravenous anesthesia combined with postoperative wound analgesia. Results the changes of T lymphocytes and immune stress indexes were observed within 7 days after anesthesia. The infection rate of patients in the observation group was 3.77% lower than that in the control group (21.15), the difference was statistically significant (P 0.05), and there was no significant difference in T lymphocyte index and norepinephrine between the observation group and the control group at different time points before and after anesthesia. In the observation group, the blood glucose values at different time after anesthesia were significantly different from those before anesthesia. The levels of cortisol and epinephrine at 72 hours after operation were higher than those before anesthesia and were lower than those in the control group at the same time. The difference was statistically significant (P 0.05), and that of the control group after operation was lower than that before anesthesia, and the difference was statistically significant (P 0.05). At 72 hours after operation, the ratio of CD8 CD4 / CD8 was lower than that before anesthesia. The difference was statistically significant (P 0.05). Stress indexes were higher than those before anesthesia at different time points after operation. Conclusion intravenous general anesthesia combined with epidural anesthesia combined with postoperative epidural analgesia has a certain effect on postoperative respiratory tract infection, and it has little interference on T lymphocytes and obvious anti-stress state. It may play a role in reducing postoperative infection.
【作者單位】： 成都市第七人民醫(yī)院麻醉科;攀枝花市攀鋼總醫(yī)院麻醉科;
【基金】：四川省科技廳科技支撐計(jì)劃(2013FZ2329)
【分類號】：R614;R735.2

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