硬膜外麻醉可有效降低术后血液的高凝状态

Epidural anesthesia can effectively decrease postoperative hypercoagulation after lower-abdominal surgery

目的探讨不同麻醉方法对围术期凝血功能的影响。方法选择30例ASA I、II级择期全子宫切除术病人,随机分为3组:连续硬膜外麻醉组(E组,n =10)、硬膜外麻醉复合全麻组(G+E组,n =10)和单纯全麻组(G组,n =10)。E组与G+E组术后采用病人自控硬膜外镇痛(PCEA),G组术后采用经静脉病人自控镇痛(PCA),维持VAS评分小于3分。分别于麻醉前(T0)、术毕即刻(T1)、术后24 h(T2)和72 h(T3)采集静脉血测定应激激素[去甲肾上腺素(NE)与肾上腺素(E)]和凝血参数[血小板(Plt)、凝血活酶时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(FIB)和TAT(凝血酶—抗凝血酶复合物)]。结果G组病人围术期NE,E水平均明显高于基础值及其它两组(P <0.05,P <0.01),G+E组与E组的NE水平围术期无明显变化且无组间差异。3组病人围术期Plt,PT和APTT均在正常范围波动;三组病人FIB水平术毕(T1)均明显降低(P <0.05),术后期则显著升高(P <0.05),且在T3达到高峰,G+E组和G组病人在T3的FIB水平均明显高于E组(P <0.05)。G+E组与G组病人的TAT水平在T1明显高于T0(P <0.01);而E组则无变化,但在术后期E组病人的TAT水平明显降低(P <0.05);E组及G+E组病人在T1,T2的TAT含量明显低于G组(P<0.01);E组病人围术期的TAT含量较G+E组明显降低(P <0.05)。结论连续硬膜外麻醉及?

Objectives] To investigate the effect of different anesthesia techniques on coagulation function during perioperative period. Thirty patients with hysteromyoma were electively selected and randomized into three Groups: Group E (Continued epidural anesthesia, n =10), Group G+E (Epidural anesthesia combined General anesthesia, n =10) and Group G (General anesthesia, n =10). Patients in Groups E and G+E were postoperatively administrated to PCEA (Patient Controlled Epidural Analgesia) and in Group G for PCA (Patient Controlled Analgesia) with VAS maintained below 3. Venous blood samples were taken in pre-anesthesia (T0), the end of operation (T1), and postoperative 24 hrs (T2) and 72 hrs (T3) to measure catecholamine (E, NE) concentration, coagulation parameters (Plt, PT, APTT, FIB, and TAT). The NE and E concentration at T1, T2 and T3 in Group G were obviously elevated than T0 (P <0.05) and increased much more than other Groups (P <0.01), but no significant difference between Group G+E and E. FIB level was obviously decreased in all Groups at T1, and then remarkably increased after operation and peaked at T3. FIB level in Group G+E and G at T3 was much higher than Group E (P <0.05). TAT contents in Group G+E and G at T1 were significantly elevated than T0 (P <0.01) and subsequently returned to normal at T2, T3, but unchanged at T1 in Group E. TAT level in Group E at T2, T3 was obviously reduced than pre-anesthesia and much lower than other Groups (P <0.05). [Conclusions] Continued epidural anesthesia and epidural anesthesia combined general anesthesia can reduce stress responses to lower abdominal surgery. Continued epidural anesthesia can effectively decrease postoperative hypercoagulation followed by lower abdominal operation.