抑肽酶血液麻醉及血栓弹性描记图在妇科恶性肿瘤根治术中的价值  

The value of aprotinin blood anesthesia and thrombelastography used in the radical excision of gynecologic malignancy

作　　者：易斌[1] 陶国才[1] 毕敏[1] 刘怀琼[1] 

机构地区：[1]第三军医大学西南医院麻醉科,重庆400038

出　　处：《重庆医学》2004年第3期379-381,共3页Chongqing medicine

摘　　要：目的　探讨抑肽酶血液麻醉和血栓弹性描记图在妇产科恶性肿瘤根治术中的运用价值。方法　 1 0 8例择期施行根治术的妇科恶性肿瘤病例 ,根据是否使用了抑肽酶分为两组 :实验组 (A组 ,4 0例 )在麻醉诱导后静注抑肽酶 1 1 1 2EPU后持续泵注抑肽酶 2 78EPU/h ,直至手术后 2h停药 ;对照组 (B组 ,6 8例 )持续泵注生理盐水。在诱导前、手术开始 2h、4h、术毕、术后 1 2h时间点上抽血检测血常规、血栓弹性描记图 (thrombelastography ,TEG)、凝血 4项指标。观察两组围术期的TEG和凝血功能检查变化情况以及术中出血量、围术期输血率和平均输血量。结果　实验组在术中出血量、围术期输血率和平均输血量都明显少于对照组 ,并且术中凝血功能状态保持相对的稳定。在监测凝血功能状态上 ,血栓弹性描记图比常规凝血 4项指标更具有价值。结论　血栓弹性描记图的监测和抑肽酶血液麻醉的运用在妇科恶性肿瘤根治手术中具有稳定凝血功能状态、减少围手术期出血量、输血量和输血率的作用 ,具有较高的应用价值。Objective To investigate the value of aprotinin blood anesthesia and thrombelastography used in the radical excision of gynecologic malignancy.Methods One hundred eight patients with gynecologic malignancy undergoing radical excision were divided into two groups according to whether or not use aprotinin.Experiment group (group A,40 patients) was injected with 1 112 EPU aprotinin and pumped with 278EPU/h until 2 h after operation.The contrast group (group B,68 patients) was treated with 0.9% NS.The venous blood was withdrawal for blood routine,thrombelastography and normal coagulable function at the time of preinduced,2h and 4h following the operation beginning,time of operative completion,12h after operation.The change of TEG and normal coagulable state were monitored during the whole surgery.And the volume of transfusion and hemorrhage between two groups was contrasted.Results The preoperative coagulable state of experiment group was kept relatively stable during the operation.However,hypercoagulable state of contrast group aggravated following the operation beginning and some of them changed to hypocoagulable state.The volumes and rates of hemorrhage and transfusion was smaller in group A than in group B.TEG is a more useful tool than normal coagulable state to screen patients with hypercoagulable states.Conclusions Aprotinin blood anesthesia and TEG monitor can stabilize the coagulable state,reduce the volumes and rates of hemorrhage and transfusion,and is worth using in the surgery of normal operations of gynecologic malignancy.

关 键 词：麻醉 抑肽酶 血栓弹性描记图 癌症 

分 类 号：R614[医药卫生—麻醉学]