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目的探讨胸段硬膜外阻滞复合静脉全麻联合自控硬膜外镇痛对老年食管癌患者术后呼吸功能及肺部感染发生率的影响。方法抽取2013年5月—2016年12月周口市中心医院84例老年食管癌患者,按照随机数表法分组,各42例。对照组给予全凭静脉麻醉联合自控静脉镇痛。观察组给予胸段硬膜外阻滞复合静脉全麻联合自控硬膜外镇痛。记录两组不同时段[T0(麻醉诱导前)、T1(切皮即刻)、T2(拔管后)]呼吸功能指标[呼吸频率(RR)、分钟通气量(MV)、血氧饱和度(Sp O2)]变化,统计两组术后肺部感染发生率。结果 T0时段两组RR、MV、Sp O2差异无统计学意义(P>0.05),观察组T1、T2时段RR、MV、Sp O2与T0时段比较无明显波动(P>0.05),对照组T1、T2时段RR、MV、Sp O2较T0时段出现明显波动(P<0.05);观察组术后肺部感染发生率4.76%(2/42)低于对照组19.05%(8/42),差异有统计学意义(P<0.05)。结论胸段硬膜外阻滞复合静脉全麻联合自控硬膜外镇痛对老年食管癌患者呼吸功能影响小,对降低术后肺部感染发生率具有重要意义。
Objective To investigate the effect of thoracic epidural block combined intravenous anesthesia combined with controlled epidural analgesia on postoperative respiratory function and incidence of pulmonary infection in elder patients with esophageal cancer. METHODS: Eighty-four elder patients with esophageal cancer in Zhoukou Central Hospital from May 2013 to December 2016 were selected and grouped according to the random number table method, with 42 cases in each group. The control group was given total intravenous anesthesia combined with controlled intravenous analgesia. The observation group was given thoracic epidural block combined intravenous anesthesia combined with controlled epidural analgesia. Two groups of different periods (T0 (before anesthesia induction), T1 (cut immediately), T2 (after extubation)] were recorded for respiratory function parameters (respiration rate (RR), minute ventilation (MV), oxygen saturation (Sp O2)] change, statistics the incidence of postoperative pulmonary infection in both groups. Results There was no significant difference in RR, MV, Sp O2 between the two groups at T0 (P>0.05). There was no significant fluctuation in RR, MV, Sp O2 and T0 during the T1 and T2 periods in the observation group (P>0.05). RR, MV, and Sp O2 in the T2 period were significantly higher than those in the T0 period (P<0.05). The incidence of postoperative pulmonary infection in the observation group was 4.76% (2/42) lower than that in the control group (19.05%, 8/42). Statistically significant (P<0.05). Conclusion Thoracic epidural anesthesia combined with general anesthesia combined with controlled epidural analgesia has little effect on respiratory function in elder patients with esophageal cancer, which is of great significance for reducing the incidence of postoperative pulmonary infection.