不同麻醉方式对老年人全髋置换术后下呼吸道感染的影响

摘要

Objective To investigate the effects of different anesthesia approached on postoperative lower respiratory tract infection in elderly patients undergoing total hip arthroplasty. Methods Fifty six patients aged 65 years who underwent total hip arthroplasty we re randomly assigned to receive intratracheal general anesthesia (control group, n=34) or general anesthesia combined with epidural block(combination group, n=22). The venous blood samples were taken before (T1) operation, during oper-ation(T2) and immediately (T3), 24h (T4) and 7d (T5) after operation. The subset of T lymphocytes (CD3+, CD4+, CD8+) were measured with flow cytometry, and the incidence of postoperative lower respiratory tract infections within 7 days was documented. Results There was no significant difference in subsets of T lymphocyte (CD3+, CD4+, CD8+) at T1 between two groups. The serum levels of CD3+[(60.7±3.7)%, (58.9±3.1)%], CD4+[(37.5±5.0)%, (36.3±3.8)%] T lymphocyte were higher in combination group than those in control group at T2 and T3(P<0.01);however, there was no significant difference at T4 and T5 between two groups(P>0.05). Two pa-tients in control group were complicated with lower respiratory tract infections within 7 d after operation with a infection rate of 5.88%, while no patients had infection in combination group. Conclusion The general anesthesia combined with epidural block may improve the perioperative immune status with a reduced risk of postoperative lower respiratory tracts infections.%目的：探讨气管内插管静脉复合全麻与硬膜外阻滞+复合全麻两种不同麻醉方式对老年人全髋置换术后发生下呼吸道感染的影响。方法选择年龄≥65岁的全髋置换术患者56例，依据随机数字表法分为气管内插管静脉复合全麻组（对照组）34例，硬膜外阻滞+复合全麻组（阻滞组）22例。分别于术前（T1）、术中（T2）、术毕即刻（T3）和术后1d（T4）、7d（T5）用流式细胞术测定血清T淋巴细胞亚群（CD3+、CD4+、CD8+）水平，并统计术后7d的下呼吸道感染发生率。结果两组T1时点的CD3+、CD4+、CD8+细胞水平的差异均无统计学意义（均P＞0.05）；阻滞组T2、T3时点的CD3+[（60.7±3.7）%、（58.9±3.1）%]、CD4+[（37.5±5.0）%、（36.3±3.8）%]细胞水平均高于对照组，差异均有统计学意义（均P＜0.05）；两组T4、T5时点的CD3+[（59.7±3.4）%、（61.4±4.3）%]、CD4+[（36.6±4.2）%、（37.6±4.9）%]细胞水平之间的差异均无统计学意义（均P＞0.05）；术后7d内，对照组有2例（5.88%）发生下呼吸道感染，阻滞组未发生。结论采用硬膜外阻滞复合全麻可以改善老年患者围术期的免疫抑制状态，有利于降低其术后发生下呼吸道感染的危险。