硬膜外麻醉复合全凭静脉麻醉对老年腹部手术患者免疫功能的影响
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摘要
目的探讨硬膜外麻醉复合全凭静脉麻醉对老年腹部手术患者免疫功能的影响。方法回顾性分析2017年5月至12月在某院行腹部手术治疗的老年患者104例临床资料,按照不同麻醉方式将其分为对照组和观察组,各52例。观察组行硬膜外麻醉复合全凭静脉麻醉,对照组行全凭静脉麻醉。观察两组免疫功能、呼吸功能及麻醉后恢复情况。结果对照组术后6 h、24 h CD3~+、CD4~+水平比观察组低,CD8~+比观察组高,差异有统计学意义(P<0.05);对照组拔管后血氧饱和度、通气量比观察组低,呼吸频率比观察组高,差异有统计学意义(P<0.05);对照组苏醒时间、自主呼吸时间及拔管时间均比观察组高,差异有统计学意义(P<0.05)。结论硬膜外麻醉复合全凭静脉麻醉可有效保护患者的呼吸功能,改善机体免疫功能,缩短患者麻醉苏醒时间及拔管时间,利于患者术后康复。
Objective To investigate the effect of epidural anesthesia combined with total intravenous anesthesia(TIVA) on immune function in senile patients with abdominal surgery.Me thods The clinical data of 104 senile patients with abdominal surgery from May to December,2017 were retrospectively analyzed.The patients were divided into the control group and the observation group by different anesthesia methods with 52 cases in each group.The Observation group was given epidural anesthesia combined with TIVA while the control group was given TIVA.The immune function,respiratory function,post-anesthesia recovery in two groups were observed.Re s ults The CD3~+and CD4~+levels 6 h and 24 h after the operation of the control group were lower than those in the observation group and the level of CD8~+in the control group was higher than that of the observation groupt.The difference showed statistical significance(P <0.05).After extubation,the oxygen saturation and ventilation volume in the control group were lower than those in the observation group while the respiratory rate of the control group was higher than that of the observation group.The difference showed statistical significance(P <0.05).The awakening time,spontaneous breathing time,extubation time in the control group were higher than those in the observation group and the difference showed statistical significance(P<0.05).Conclus ion Epidural anesthesia combined with TIVA can effectively protect patients' respiratory function,improve immune function,shorten awakening time and extubation time,promoting postoperative recovery.
Objective To investigate the effect of epidural anesthesia combined with total intravenous anesthesia(TIVA) on immune function in senile patients with abdominal surgery.Me thods The clinical data of 104 senile patients with abdominal surgery from May to December,2017 were retrospectively analyzed.The patients were divided into the control group and the observation group by different anesthesia methods with 52 cases in each group.The Observation group was given epidural anesthesia combined with TIVA while the control group was given TIVA.The immune function,respiratory function,post-anesthesia recovery in two groups were observed.Re s ults The CD3~+and CD4~+levels 6 h and 24 h after the operation of the control group were lower than those in the observation group and the level of CD8~+in the control group was higher than that of the observation groupt.The difference showed statistical significance(P <0.05).After extubation,the oxygen saturation and ventilation volume in the control group were lower than those in the observation group while the respiratory rate of the control group was higher than that of the observation group.The difference showed statistical significance(P <0.05).The awakening time,spontaneous breathing time,extubation time in the control group were higher than those in the observation group and the difference showed statistical significance(P<0.05).Conclus ion Epidural anesthesia combined with TIVA can effectively protect patients' respiratory function,improve immune function,shorten awakening time and extubation time,promoting postoperative recovery.
引文
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[8]马岁谋.硬膜外复合全麻和全凭静脉麻醉对胆管结石梗阻患者术后肝功能及肠屏障功能的影响[J].医学临床研究,2016,33(12):2468-2471.
[9]何相好,郭霞,何智勇,等.不同麻醉方式对腹部手术患者术后感染与免疫功能及血清IL-6和TNF-α水平的影响研究[J].中华医院感染学杂志,2017,27(5):1074-1077.
[10]洪彬源,陈桂纯,王云花,等.多模式麻醉药物合用对结肠癌根治术患者免疫功能的影响[J].广东医学,2016,37(20):3080-3083.
[11]张远,解雅英.硬膜外复合全身麻醉对梗阻性黄疸术后肠屏障功能的影响[J].临床麻醉学杂志,2016,32(5):438-440.
[12]刘才堂,李雪萍,郭耀军,等.不同麻醉方式对老年患者上腹部手术肺部感染的影响[J].河北医学,2017,23(1):119-122.
[2]宋国军.硬膜外麻醉联合全凭静脉麻醉对腹腔镜术中及术后应激反应、凝血功能的影响[J].海南医学院学报,2017,23(14):1918-1921.
[3]罗中兵,张燕辉,宋晓阳,等.联合腰麻硬膜外麻醉或全凭静脉麻醉用于经皮肾镜碎石术[J].重庆医学,2015,44(2):251-253.
[4]杨涛,周日永,张竞雄,等.静脉麻醉与硬膜外麻醉对十二指肠胰头癌老年患者术后肺部感染的影响分析[J].中华医院感染学杂志,2016,26(9):2050-2052.
[5]谭钢,郭晓明.全凭静脉麻醉复合神经阻滞于胸腔镜手术的临床效果[J].海南医学,2017,28(18):3055-3057.
[6]孙付国,金亮,徐丹,等.硬膜外复合全麻对老年高血压患者腹部手术后并发症的影响[J].现代生物医学进展,2015,15(36):7098-7100.
[7]宋俊刚,毕中先,唐俊霞,等.不同麻醉方式对上腹部手术老年患者肺功能指标与炎症因子及T淋巴细胞亚群的影响[J].中华医院感染学杂志,2017,27(17):3929-3932.
[8]马岁谋.硬膜外复合全麻和全凭静脉麻醉对胆管结石梗阻患者术后肝功能及肠屏障功能的影响[J].医学临床研究,2016,33(12):2468-2471.
[9]何相好,郭霞,何智勇,等.不同麻醉方式对腹部手术患者术后感染与免疫功能及血清IL-6和TNF-α水平的影响研究[J].中华医院感染学杂志,2017,27(5):1074-1077.
[10]洪彬源,陈桂纯,王云花,等.多模式麻醉药物合用对结肠癌根治术患者免疫功能的影响[J].广东医学,2016,37(20):3080-3083.
[11]张远,解雅英.硬膜外复合全身麻醉对梗阻性黄疸术后肠屏障功能的影响[J].临床麻醉学杂志,2016,32(5):438-440.
[12]刘才堂,李雪萍,郭耀军,等.不同麻醉方式对老年患者上腹部手术肺部感染的影响[J].河北医学,2017,23(1):119-122.