腰硬联合麻醉对腹腔镜子宫切除术老年患者凝血功能与下肢DVT的影响  

Effect of combined spinal-epidural anesthesia on coagulation function and lower extremity DVT in elderly patients undergoing laparoscopic hysterectomy

作　　者：袁媛 李佳怡 卢强 Yuan Yuan;Li Jiayi;Lu Qiang(Department of Anesthesiology,the 909th Hospital of PLA Joint Logistics Support Force,Zhangzhou 363000,Fujian,China;Department of Obstetrics and Gynecology,the 909th Hospital of PLA Joint Logistics Support Force,Zhangzhou 363000,Fujian,China;Department of General Surgery,the 909th Hospital of PLA Joint Logistics Support Force,Zhangzhou 363000,Fujian,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇九医院麻醉科,福建漳州363000 [2]中国人民解放军联勤保障部队第九〇九医院妇产科,福建漳州363000 [3]中国人民解放军联勤保障部队第九〇九医院普外科,福建漳州363000

出　　处：《血管与腔内血管外科杂志》2021年第9期1123-1128,共6页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨腰硬联合麻醉对腹腔镜子宫切除术老年患者凝血功能与下肢深静脉血栓形成(DVT)的影响。方法收集2020年2月至2021年2月中国人民解放军联勤保障部队第九〇九医院行腹腔镜子宫切除手术112例老年患者临床资料,根据麻醉方式不同分为A组(n=57,采用腰硬联合麻醉)和B组(n=55,采用全身麻醉)。比较两组患者不同时间点收缩压(SBP)、舒张压(DPB)、心率(HR)、视觉模拟评分法(VAS)疼痛评分、Ramsay镇静评分、苏醒质量、凝血功能指标[凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(Fib)]、下肢DVT发生率。结果气腹后10 min、气腹后30 min和术毕时,A组患者HR低于B组患者,SBP、DPB高于B组患者;术后6 h、术后12 h、术后24 h,A组患者VAS疼痛评分均低于B组患者;术后6 h、术后24 h,A组患者APTT长于B组患者,Fib水平低于B组患者,差异有统计学意义(P<0.05)。A组患者意识恢复时间、自主呼吸恢复时间、清醒时间短于B组患者,差异有统计学意义(P<0.05)。两组患者Ramsay镇静评分和DVT发生率比较,差异无统计学意义(P>0.05)。结论腹腔镜子宫切除术老年患者术中应用腰硬联合麻醉相较于全身麻醉可有效平稳术中血压和HR,减轻术后疼痛,提高苏醒质量,减轻术后高凝状态。Objective To explore the effect of combined spinal-epidural anesthesia(CSEA)on coagulation function and deep venous thrombosis(DVT)of the lower extremity in elderly patients undergoing laparoscopic hysterectomy.Method The clinical data of 112 elderly patients who underwent laparoscopic hysterectomy from February 2020 to February 2021 in the 909th Hospital of PLA Joint Logistics Support Force were collected.According to the different anesthesia methods,all subjects were divided into group A(n=57,with CSEA)and group B(n=55,using general anesthesia).The systolic blood pressure(SBP),diastolic blood pressure(DPB),heart rate(HR),visual analogue scale(VAS)and Ramsay sedation score,recovery quality,coagulation function indicators[prothrombin time(PT),thrombin time(TT),activated partial prothrombin time(APTT),fibrinogen(Fib)]at different time points,incidence of lower extremity DVT were compared between the two groups of patients.Result At 10 min and 30 min after pneumoperitoneum,and after surgery,HR in group A was lower than that in group B,while SBP and DPB were higher than those in group B(P<0.05).At 6 h,12 h,and 24 h after surgery,scores of VAS pain in group A were lower than those in group B(P<0.05).At 6 h and 24 h after surgery,APTT in group A was longer than that in group B,while Fib level was lower than that in group B.The differences were statistically significant(P<0.05).The recovery time of consciousness and autonomous respiration,and awake time in group A were shorter than those in group B,and the difference was statistically significant(P<0.05).The Ramsay sedation score and the incidence of DVT were not statistically different between the two groups of patients(P>0.05).Conclusion The employment of CSEA can effectively stabilize intraoperative blood pressure and HR,alleviate postoperative pain,improve recovery quality and reduce postoperative hypercoagulability in elderly patients undergoing laparoscopic hysterectomy compared with general anesthesia.

关 键 词：腹腔镜子宫切除术 老年患者 腰硬联合麻醉 全身麻醉 凝血功能 深静脉血栓形成 

分 类 号：R543[医药卫生—心血管疾病]