本文選題：肺結核　切入點：術后感染　出處：《中華醫(yī)院感染學雜志》2017年10期 　論文類型：期刊論文

【摘要】：目的探討肺結核患者胸部手術后不同鎮(zhèn)痛方式對術后感染的影響,為臨床用藥提供依據。方法選取2012年12月-2016年5月紹興市立醫(yī)院行手術治療的肺結核患者320例,分別行胸腔鏡下肺部分切除術、肺大泡切除術及膿胸切除術,所有患者采用常規(guī)硬膜外導管置入后全身麻醉,根據術后鎮(zhèn)痛方式不同分為靜脈鎮(zhèn)痛組及硬膜外鎮(zhèn)痛組,每組各160例;觀察兩組患者醫(yī)院感染率及醫(yī)院感染部位分布,行體液培養(yǎng)及病原學分析;采用熒光免疫流式細胞術,分別測定兩組患者術前及鎮(zhèn)痛后2d的T淋巴細胞亞群(CD_4~+、CD_8~+、CD_4~+/CD_8~+)的數(shù)量。結果 320例患者中發(fā)生醫(yī)院感染64例,感染率為20.00%;兩組患者主要感染部位為呼吸道、胃腸道、尿道、切口;共分離出病原菌64株,其中靜脈鎮(zhèn)痛組檢出病原菌40株,革蘭陰性菌、革蘭陽性菌、真菌分別占72.50%、25.00%和2.50%;硬膜外鎮(zhèn)痛組檢出病原菌24株,革蘭陰性菌、革蘭陽性菌、真菌分別占66.66%、29.17%和4.17%;鎮(zhèn)痛2d后,兩組患者CD_4~+、CD_8~+、CD_4~+/CD_8~+均有所降低,其中靜脈鎮(zhèn)痛組CD_4~+、CD_8~+,硬膜外鎮(zhèn)痛組CD_4~+與治療前相比差異有統(tǒng)計學意義(P0.05),靜脈鎮(zhèn)痛組CD_4~+/CD_8~+,硬膜外鎮(zhèn)痛組CD_8~+、CD_4~+/CD_8~+較術前出現(xiàn)下降,但差異無統(tǒng)計學意義。結論硬膜外鎮(zhèn)痛組患者術后感染率低于靜脈鎮(zhèn)痛組患者,兩組患者感染類型及病原學構成相似,鎮(zhèn)痛2d后T淋巴細胞亞群均有所改變,但硬膜外鎮(zhèn)痛組波動更小,其是否與術后感染相關還需進一步研究。
[Abstract]:Objective to investigate the effect of different analgesic methods on postoperative infection in patients with pulmonary tuberculosis after thoracic surgery, and to provide evidence for clinical use. Methods 320 patients with pulmonary tuberculosis undergoing surgical treatment in Shaoxing City Hospital from December 2012 to May 2016 were selected. The patients were divided into intravenous analgesia group and epidural analgesia group according to the postoperative analgesia methods. The patients were subjected to partial pneumonectomy, alveolectomy and abscess resection under thoracoscope respectively. All patients were anesthetized by routine epidural catheterization after general anesthesia, and were divided into intravenous analgesia group and epidural analgesia group. The nosocomial infection rate and nosocomial infection site distribution were observed, body fluid culture and etiological analysis were performed, and fluorescence immunoflow cytometry (FFCM) was used to analyze the nosocomial infection rate and nosocomial infection site. The number of T lymphocyte subsets (CD4 ~ CD8- / CD8 ~) of T lymphocyte subsets before operation and 2 days after analgesia in the two groups were measured. Results the nosocomial infection occurred in 64 patients (20.00%) in 320 patients, and the main sites of infection were respiratory tract, gastrointestinal tract, urethra, and urethra. In the group of intravenous analgesia, there were 40 strains of pathogenic bacteria, 40 strains of Gram-negative bacteria, gram-positive bacteria, and fungi accounted for 72.50% and 2.50%, respectively, in epidural analgesia group, 24 strains of pathogenic bacteria, 24 strains of gram-negative bacteria, and 2.50% of gram-positive bacteria were found in epidural analgesia group. After 2 days of analgesia, CD4 ~ + CD8 ~ / CD8 ~ / CD8 ~ / CD8 ~ / CD8 ~ / CD8 ~% decreased in the two groups, especially in the vein analgesia group CD4 ~ + CD4 ~ ~ ~, the epidural analgesia group in which there was a significant difference between before and after treatment (P0.05), and in the intravenous analgesia group, CD4 ~ / -CD8 ~ + -CD8 ~ / -CD8 ~ ~, there was a significant difference between the epidural analgesia group and the pre-treatment group. In epidural analgesia group, CD8 ~ / CD4 ~ / CD8-1 decreased, but the difference was not statistically significant. Conclusion the postoperative infection rate of epidural analgesia group is lower than that of intravenous analgesia group, and the infection types and etiological composition of the two groups are similar. After 2 days of analgesia, T lymphocyte subsets were all changed, but the fluctuation of epidural analgesia group was smaller, and whether it was related to postoperative infection should be further studied.
【作者單位】： 紹興市立醫(yī)院麻醉科;
【基金】：浙江省醫(yī)藥衛(wèi)生一般研究計劃基金資助項目(2015KYB403)
【分類號】：R614

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