不同麻醉方式对HIV感染者麻醉并发症的影响

目的比较全身麻醉、局部麻醉及腰硬联合麻醉对HIV感染者麻醉并发症的影响。方法 HIV感染患者行手术治疗79例,根据患者病情及手术方式选择全身麻醉(A组)、局部麻醉(含局部浸润麻醉及外周神经阻滞,B组)和腰硬联合麻醉(C组)。记录麻醉前(T0)、诱导后(T1)、切皮时(T2)及术毕(T3)各时点HR、MAP和SpO2及术前CD4+T细胞计数、手术切口类型和术后并发症发生率。结果 C组术前CD4+T淋巴细胞计数较其余2组高,ASA分级较其余2组低(P<0.01);B组麻醉时间较A组短,术后发热及术后并发症总发生率较其他2组低(P<0.05或P<0.01)。与A组比较:B组T1-T3时点HR较快、MAP较高、SpO2较低;C组HR T1时点较快、T3时点较慢,T1-T3时点SpO2较低(P<0.05或P<0.01)。与C组比较:B组T2、T3时点HR较快,T1-T3时点MAP较高、SpO2较低(P<0.05或P<0.01)。结论 3种麻醉方式均可安全用于HIV感染患者,但全身麻醉及腰硬联合麻醉围术期生命体征较平稳,局部麻醉术后并发症发生率较低。

Influences of Different Anesthesia Methods on Anesthetic Complications in HIV-infected Patients

Objective To compare the influences of general anesthesia, local anesthesia and lumbar epidural anesthesia on anesthetic complications in HIV-infected patients. Methods Seventy-nine HIV- positive patients were divided into three groups according to patients＇ condition and surgical approach： general anesthesia group （group A）,local anesthesia group （including local infiltration anesthesia and peripheral nerve block, group B）, and lumbar epidural anesthesia group （group C）. Heart rate（HR）, mean arterial pressure（MAP）and SpO2 were measured before anesthesia induction（T0）, after anesthesia induction（T1）, at skin incision（T2）and at the end of operation（T3）, and the number of CD4-positive T lymphocytes was determined before operation. In addition, surgical incision types and postoperative complications were recorded in all patients. Results Compared with group C, the number of CD4- positive T lymphoeytes decreased and ASA classification increased in the other two groups （P〈0.01）. Compared with group B, anesthesia time increased in group A and postoperative fever and complications increased in the other two groups （P〈0.05 or P〈0.01 ）. Compared with group A, HR and MAP increased but SpO2 decreased in group B at T1-T3, HR increased in group C at T1 and decreased at T3, and SpO2 decreased in group C at T1-T3 （P〈0.05 or P〈0.01 ）. Compared with group C, HR inc- reased in group B at T2 and T3, and MAP increased but SpO2 decreased in group B at T1-T3 （P〈0.05 or P〈0.01）. Conclusion The three different anesthesia methods can be used for surgical treatment in HIV-infected patients. General anesthesia and lumbar epidural anesthesia lead to stable vital signsduring perioperative period,while local anesthesia contribute to low incidence of postoperative compli- cations.