不同麻醉方法对下肢骨关节手术患者围术期凝血功能的影响  

The effectsof coagulation function inperioperative period on patients undergone Lower limb joint operation with different anesthesia methods

作　　者：李云龙 王华 叶慧仪 梁亚力 钟克宣 杨耿华 刘发全 

机构地区：[1]广东省东莞市大岭山医院麻醉科,523820 [2]广东省东莞市大岭山医院外科,523820 [3]广东省东莞市大岭山医院检验科,523820

出　　处：《中国现代药物应用》2013年第8期9-11,共3页Chinese Journal of Modern Drug Application

基　　金：东莞市科技计划医疗卫生类科研一般项目(项目编号:201210515042198)

摘　　要：目的探讨不同麻醉方法对患者下肢骨关节手术围术期凝血功能的影响。方法选择择期行下肢骨关节手术的患者90例,ASAⅠ-Ⅲ级,随机分为腰硬联合麻醉组(CSEA组)、硬膜外麻醉组(EA组)和全麻组(GA组),每组30例。分别于麻醉前(T0)、麻醉后6h(T1)、术后24h(T2)采静脉血行凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fbg)等凝血功能检测。结果三组组内比较PT、TT值T1、T2较麻醉前延长(P<0.05);CSEA组、EA组组内比较APTT值T1、T2较麻醉前延长(P<0.05),GA组组内比较APTT值各时点较麻醉前麻醉前差异无统计学意义(P>0.05);CSEA组、EA组组内比较Fbg值T1、T2较麻醉前降低(P<0.05);GA组组内比较Fbg值各时点较麻醉前麻醉前差异无统计学意义(P>0.05);上述各项指标麻醉后各时间点组间比较差异无统计学意义(P>0.05);GA组DVT发生率明显高于CSEA组、EA组(P<0.05)。结论腰硬联合麻醉、硬膜外麻醉能有效的预防患者下肢手术围术期血液高凝状态,有利于减少围术期血栓性并发症的发生;腰硬联合麻醉是下肢骨关节手术首选的麻醉方法[1]。Objective Comparison the a effects of coagulation function inperioperative period on patients undergone Lower limb joint operation with different anesthesia methods. Methods 90 cases of undergoing selective lower limb joint operation （ ASA Ⅰ -Ⅲgrade ） were randomly divided into three groups ： group of combined spinal and epidural anesthesia for 30 cases（ CSEA group） ,group of epidural anesthesia for 30 cases（ EA group） and group of general anesthesia for 30 cases （ GA group）. Parameters of coagulation function including in prothrombin time （ PT）, activated partial thromboplastin time （ APTT）, thrombin time （TT） and fibrinogen （Fbg） were detected before anesthesia （ T0 ）, 6 hours after anesthesia （ T1 ） and 24 hours after anesthesia （ T2 ） by withdrawing blood from patientg veins. Results Within every group time of PT or TT at T1 and T2 time points was longer than from that at TO time point （ P 〈 0.05 ）. Within CSEA group and EA group time of AprfT at T1 and T2 time points was longer than from that at TO time point（P 〈0. 05） ,but Within GA group time of APTT at T1 and T2 time points was not significantly different from that at TO time point in H group （ P 〉 0. 05 ）. Within CSEA group and EA group content of Fbg at Tl and T2 time points was longer than from that at TO time point （ P 〈 0.05 ） , but Within GA group content of Fbg at T1 and T2 time points was not significantly different from that at TO time point in H group （ P 〉 0.05 ）. Every parameters of coagulation function with comparison among groups at T1 and T2 time points was not significantly different from that at TO time point in H group （ P 〉 0.05 ）, GA group was significantly higher than the incidence of DVT CSEA group, EA group （ P 〈 0.05 ）. Conclusion Combined spinal and epidural anesthesia and epidural anesthesia will more effectively prevent rejection heperco- agulabale state on patients of Lower limb joint operation , reduce thrombotic complication in preoper

关 键 词：腰硬联合麻醉 下肢骨关节手术 围术期 凝血功能 影响 

分 类 号：R614[医药卫生—麻醉学]