目的 探讨腰麻-硬膜外联合麻醉对老年开腹手术患者认知功能障碍、肺部感染的影响.方法选取接受开腹手术治疗的160例老年患者进行回顾性分析,其中80例采取腰麻-硬膜外联合麻醉(A组)、80例采取全身麻醉(B组),对比两组患者术后短期认知功能、肺部感染的发生率.结果 麻醉前,A、B两组患者的心率(HR)、平均动脉压(MAP)、动脉血氧饱和度(SpO2)水平差异均无统计学意义(P>0.05);手术10 min、术后5 min,A组的HR、MAP均低于B组(P<0.05);两组患者的SpO2水平在各个时刻比较,差异无统计学意义(P>0.05);手术后24 h,A组患者的简明精神状态量表评分高于B组(P<0.05);手术后24 h,A组患者的术后认知功能障碍(POCD)发生率11.25%低于 B 组的26.25%(P <0.05);术后24 h、术后72 h,B 组的白细胞介素-6(IL-6)、白细胞介素-8(IL-8)高于A组(P<0.05);术后24 h,B组的CD4 +/CD8 +水平低于A组(P<0.05);手术后7 d内,A组肺部感染发生率6.25%(5/80)低于B组患者的16.25%(13/80),差异有统计学意义(χ2=4.006,P=0.045).结论 腰麻-硬膜外联合麻醉对老年开腹手术患者认知功能影响较小、肺部感染发生率较低,但是对患者的血流动力学影响较大.%Objective To explore the effect of combined spinal and epidural anesthesia on cognitive impair -ment and pulmonary infection in elderly patients with laparotomy.Methods One hundred and sixty elderly patients with laparotomy were retrospectively analyzed,including 80 cases with combined spinal epidural anesthesia(A group),80 ca-ses of general anesthesia(B group).The postoperative short-term cognitive function,incidence of lung infection were compared between two groups.Results No significance differences were observed at HR,MAP and SpO2 between the two groups(P>0.05).10 min,5 min after surgery,HR and MAP within 10 minutes and 5 min postoperatively of A group were lower than those in group B(P<0.05);there was no statistical difference in SpO 2 of each time between two groups(P>0.05).The group A had a higher level of MMSE and lower incidence of POCD(11.25%)compared with group B(26.25%)(P<0.05).IL-6 and IL-8 of B group was higher than those in group A at 24h,72h postoperatively (P<0.05).The levels of CD4 +/CD8 +of group B was lower than that in A group(P<0.05)within 24h postopera-tively.The incidence of pulmonary infection of group A(6.25%)was lower than that in B group(16.25%),the differ-ence was statistically significant(χ2=4.006,P=0.045).Conclusion Combined spinal and epidural anesthesia has a smaller effect on the cognitive function of elderly patients with laparotomy,and the incidence of pulmonary infection is low,but it has an apparent influence on the hemodynamics of the patients.
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