硬膜外自控镇痛治疗对前列腺电切术术后凝血功能及血栓事件发生的影响  

Effect of Epidural Patient-controlled Analgesia Treatment on Coagulation Function and the Thrombotic Events in Patients After Transurethral Resection of the Prostate

作　　者：袁野 杨春飞 李军 钟勇 

机构地区：[1]重庆市第十三人民医院泌尿外科,重庆400053

出　　处：《血栓与止血学》2016年第3期300-302,306,共4页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的分析硬膜外自控镇痛对前列腺电切术(TURP)后患者阵发性膀胱痉挛、血栓事件发生及凝血功能的影响。方法选取2013年2月至2015年2月于我院择期作TURP手术治疗的80例患者作为研究对象,患者麻醉等级均为Ⅱ-Ⅲ级,按随机数字表法分为对照组与观察组2组,每组40例,对照组术后采用常规肌注镇痛处理,观察组术后则接受硬膜外自控镇痛,比较2组术后阵发性膀胱痉挛及血栓事件发生率,统计2组不同时间段红细胞压积(HCT)、血小板聚集率(PAgT)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(aPTT)等凝血指标的变化情况。结果术后6 h、3 d,2组PT变化对比无差异,T2、T3时间点,观察组aPTT均高于对照组,PAgT低于对照组,对比差异有统计学意义(P<0.05),T3时间点,观察组HCT低于对照组,对比差异显著(P<0.05);观察组术后VAS评分为(1.2±0.1)分,出血量为(15.9±9.1)ml,均低于对照组,2组上述指标相比差异有统计学意义(P<0.05);观察组阵发性痉挛及深静脉血栓形成发生率均为5.0%,明显低于对照组的22.5%与20.0%,2组对比差异有统计学意义(P<0.05)。结论在TURP术后采用硬膜外自控镇痛方案,可降低阵发性膀胱痉挛发生率,改善其凝血指标,降低血栓事件发生率,优化镇痛效果。Objective To analyzed the effect of epidural patient-controlled analgesia treatment on the incidence rates of paroxysmal cystospasm and thrombotic events and coagulation function in patients after tran- surethral resection of the prostate （TURP）. Methods from February 2013 to February 2015 were selected as 80 patients undergoing elective TURP in our hospital the research objects. The anaesthetic grade of the pa- tients was grade Ⅱ-Ⅲ. According to the random number table method, the patients were divided into the con- trol group and the observation group of 2 groups with 40 cases in each group. After the operation, the control group were treated with routine intramuscular analgesia, while the observation group received epidural patient- controlled analgesia. The incidence rates of paroxysmal cystospasm and thrombotic events in the 2 groups were compared. The changes of hematocrit （HCT） ,platelet aggregation rate（ PAgT）, prothrombin time（ PT）, activa- ted partial thromboplastin time（atria） and other blood coagulation indexes of the two groups at different time periods were statistically analyzed. Results In postoperative 6 h and 3 d, there was no difference in changes of PT between the 2 groups. At T2 and T3, aPTT of the observation group was higher than that of the control group, while PAgT was lower than that of the control group （ P 〈 0. 05 ）. At T3, HCT of the observation group was lower than that of the control group （ P 〈 0. 05 ） ; The VAS score of the observation group after the operation （ 1.2 ± 0. 1 ） and the bleeding volume （ 15.9 ± 9. 1 ） ml were lower than those of the control group （ P 〈 0.05 ） ; The incidence rates of paroxysmal spasm and deep venous thrombosis in the observation group （5.0% and5 0% ）were significantly lower than those in the control group（22.5% and 20. 0% ） （P 〈 0. 05 ）. Conclusion To adopt epidural patient-controlled analgesia after TURP can reduce the incidence of paroxysmal cysto- spasm, improve blood coagulation in

关 键 词：硬膜外自控镇痛 前列腺电切术 凝血功能 

分 类 号：R697.3[医药卫生—泌尿科学]