不同麻醉方式对髋关节置换术患者血流动力学指标及下肢深静脉血栓的影响  

Effect of different anesthesia methods on hemodynamic indicators and lower extremity deep vein thrombosis in patients with hip arthroplasty

作　　者：杨小宇[1] 蒋鹏[2] 王庚[1] 李秋军[1] 张文超[1] Yang Xiaoyu;Jiang Peng;Wang Geng;Li Qiujun;Zhang Wenchao(Department of Anesthesiology,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Vascular Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院麻醉科,北京100035 [2]北京积水潭医院血管外科,北京100035

出　　处：《血管与腔内血管外科杂志》2022年第10期1177-1181,共5页Journal of Vascular and Endovascular Surgery

基　　金：北京积水潭医院高层次人才“学科骨干”培养计划(XKGG202116)。

摘　　要：目的探讨不同麻醉方式对髋关节置换术患者血流动力学指标及下肢深静脉血栓(DVT)的影响。方法收集2021年1月至2022年1月北京积水潭医院收治的96例髋关节置换术患者的临床资料,根据麻醉方式的不同将其分为全麻组(n=43)和神经阻滞麻醉组(n=53)。记录两组患者的手术相关指标[手术时间、拔管时间、首次下床活动时间、住院时间、术后24 h视觉模拟评分法(VAS)评分],比较两组患者术前(T_(0))、术中(T_(1))、术毕(T_(2))、术后30 min(T_(3))时的血流动力学指标[心率(HR)、平均动脉压(MVP)],比较两组患者T_(0)、T_(2)时的凝血功能指标[凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(FIB)水平、D-二聚体(D-D)水平],分析两组患者术后下肢DVT发生率及安全性指标。结果神经阻滞麻醉组患者拔管时间、首次下床活动时间、住院时间均短于全麻组患者,术后24 h VAS评分低于全麻组患者,差异均有统计学意义(P<0.05)。T_(1)、T_(2)、T_(3)时,全麻组患者HR、MVP均低于本组T_(0),但神经阻滞麻醉组患者HR、MVP均高于全麻组患者,差异均有统计学意义(P<0.05)。T_(2)时,全麻组患者血清FIB水平、D-D水平均高于本组T_(0),TT、PT均长于本组T_(0),但神经阻滞麻醉组患者血清FIB水平、D-D水平均低于全麻组患者,TT、PT均短于全麻组患者,差异均有统计学意义(P<0.05)。全麻组患者下肢DVT发生率为16.3%(7/43),高于神经阻滞麻醉组患者的3.8%(2/53),差异有统计学意义(P<0.05)。两组患者术后安全性指标比较,差异均无统计学意义(P>0.05)。结论超声引导下的神经阻滞麻醉在髋关节置换术患者中的血流动力学稳定性较高,早期镇痛效果显著,减少了首次下床活动及出院时间,下肢DVT发生率较低,安全性较高,值得临床推广应用。Objective To investigate the effect of different anesthesia methods on hemodynamic indicators and lower extremity deep vein thrombosis(DVT)in patients undergoing hip arthroplasty.Method The clinical data of 96 patients undergoing hip replacement in Beijing Jishuitan Hospital from January 2021 to January 2022 were collected.They were divided into general anesthesia group(n=43)and nerve block anesthesia group(n=53)according to different anesthesia methods.The surgery-related indicators of operation time,extubation time,first ambulation time,hospitalization time,and 24-hour postoperative visual analogue scale(VAS)score of two groups were recorded.The hemodynamic indicators of heart rate(HR),mean arterial pressure(MVP)before the operation(T_(0)),during the operation(T_(1)),after the operation(T_(2)),and 30 minutes after the operation(T_(3))of two groups were compared.The coagulation function indexes of thrombin time(TT),prothrombin time(PT),fibrinogen(FIB)level,D-dimer(D-D)level at T_(0) and T_(2) of two groups were compared.The incidence and safety indicators of postoperative lower extremity DVT in the two groups were also analyzed.Result The extubation time,first ambulation time,and hospital stay in the nerve block anesthesia group were shorter than those in the general anesthesia group,and the VAS score at 24 h after the operation in the nerve block anesthesia group was lower than that in the general anesthesia group,the differences were statistically significant(P<0.05).At T_(1),T_(2),and T_(3),HR and MVP in the general anesthesia group were lower than at T_(0) in this group,however,HR and MVP in the nerve block anesthesia group were higher than those in the general anesthesia group,the differences were statistically significant(P<0.05).At T_(2),the levels of FIB and D-D in the general anesthesia group were higher than this group at T_(0),the TT and PT were longer than this group at T_(0),however,the levels of FIB and D-D in the nerve block anesthesia group were lower than those in the general anesthesia group,th

关 键 词：全身麻醉 神经阻滞麻醉 髋关节置换术 血流动力学 深静脉血栓 

分 类 号：R543[医药卫生—心血管疾病]