目的 探讨不同麻醉方法对老年肺癌患者术后肺部并发症的影响.方法 选择2013年3月至2015年12月于本院行手术治疗的老年肺癌患者120例为研究对象,依据就诊时的ID号码将入选患者随机分为A组(全凭静脉麻醉)、B组(吸入麻醉)及C组(硬膜外阻滞复合全身麻醉),每组各40例.比较三组患者的苏醒时间、拔管时间、术后肺部并发症发生率、术后确诊肺部感染情况及感染率.结果 C组患者苏醒时间和拔管时间均明显短于A组和B组(P<0.05).术后第3天监测结果显示,C组患者发热>38℃、白细胞计数>11.2×109/L、合并X线胸片表现、脓痰、痰培养阳性的发生率均低于A组和B组(P<0.05),A组与B组患者发热>38℃、白细胞计数>11.2×109/L的发生率比较均有显著差异(P<0.05).C组患者临床诊断为肺炎的发生率显著低于A组(P<0.05),肺部感染率显著低于A组和B组(P<0.05),且A组患者肺部感染率显著高于B组(P<0.05).结论 与全凭静脉麻醉和吸入麻醉相比,硬膜外阻滞复合全身麻醉可明显减少老年肺癌患者术后肺部并发症,在一定程度上降低了肺部感染率.%Objective To explore the different anesthesia methods on postoperative pulmonary complications in elderly patients with lung cancer.Method 120 cases of elderly patients with lung cancer who underwent surgery in our hospital from March 2013 to December 2015 were selected as the subjects. According to the ID number of patients' treatment, 120 patients were randomly divided into group A (total intravenous anesthesia), group B (inhalation anesthesia) and group C (epidural block combined with general anesthesia). The recovery time, extubation time, postoperative pulmonary complications and incidence were compared among the three groups.Result The recovery time and extubation time of group C were significantly shorter than those of group A and group B (P<0.05). On the third day after operation, the incidence of fever> 38℃, white blood cell count> 11.2×109/L, combined with X-ray performance, cough sputum, sputum culture positive rates of group C of patients were lower than group A and group B (P<0.05). There were significant differences in the incidence of fever> 38℃ and white blood cell count> 11.2×109/L between group A and group B (P<0.05). The incidence of clinical diagnosis of pneumonia in group C was significantly lower than that in group A (P<0.05), the rate of lung infection was significantly lower than that of group A and group B (P<0.05), and the rate of pulmonary infection in group A was significantly higher than that in group B (P<0.05).Conclusion Compared with total intravenous anesthesia and inhalation anesthesia, epidural block combined with general anesthesia can significantly reduce postoperative pulmonary complications in elderly patients with lung cancer, to a certain extent, reduce the rate of respiratory infection.
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