硬膜外阻滞对妇科腹腔镜手术患者血液流变学的影响

Effect of epidural anesthesia on hemorheology in patients undergoing gynecological laparoscopy

目的探讨硬膜外阻滞及硬膜外镇痛对妇科腹腔镜手术患者血液流变学及术后深静脉血栓发生率的影响。方法择期行妇科腹腔镜手术患者100例,随机平均分为全麻复合硬膜外阻滞组(GE组)和全麻组(G组),分别测定两组患者麻醉前(T0)、手术前(T1)、气腹后30min(T2)、气腹停止后30min(T3)、术后24h(T4)和术后48h(T5)6个时点的红细胞压积和血液流变学指标;术后第3天行下肢彩色B超检查,结合临床症状确定深静脉血栓发生情况。结果GE组T1血液粘度、血浆粘度、红细胞聚集性显著低于T0(P<0.05),其他各时点血液流变学指标与T0无显著差异(P>0.05);G组T2、T3、T4和T5的血液粘度、血浆粘度、红细胞聚集性与T0比较显著升高(P<0.05),并显著高于GE组(P<0.05)。GE组和G组术后深静脉血栓发生率分别为2%和8%,两组有显著差异(P<0.05)。结论妇科腹腔镜手术气腹可致血液粘滞,硬膜外阻滞及硬膜外镇痛可以改善患者血液流变学状态,从而降低妇科腹腔镜术后深静脉血栓发生率。

Objective To evaluate the effect of epidural anesthesia and patient-controlled epidural analgesia（PCEA） on hemorheology and the incidence of deep venous thrombosis in patients undergoing gynecological laparoscopy.Methods One hundred ASA I-Ⅱ patients undergoing gynecological laparoscopy were randomly allocated into 2 groups to receive general-epidural anesthesia combined with PCEA（GE group） and general anesthesia（G group）.Blood samples were taken before anesthesia（T0）,before operation（T1）,30 min after pneumoperitoneum（T2）,30 min after pneumoperitoneum cease（T3）,and 24 and 48 h after the operation（T4,T5） for hemorheological tests.Results In GE group,the blood viscosity,plasma viscosity and RBC aggregation decreased significantly at T1（P0.05）,but no significant variations were detected at the other time points.In G group,blood viscosity and plasma viscosity increased significantly from T2 to T5,and were significantly higher than those of GE group.The incidence of deep venous thrombosis of GE group（2%） was significantly lower than that of the G group（8%）.Conclusion The blood viscosity,plasma viscosity and RBC aggregation increase during gynecological laparoscopy,and can be reduced by epidural anesthesia and PCEA to lower the incidence of deep venous thrombosis.