不同麻醉方法对胃癌根治术患者围术期纤溶功能的影响

The influence in fibrinolysis of gastric cancer patients undergoing gastrectomy with different anaesthesia

目的观察比较不同麻醉方法对胃癌根治手术患者围术期的纤维蛋白溶解(纤溶)功能的影响。方法对施行胃癌根治手术的患者采用不同麻醉方式并采集静脉血检测血红蛋白浓度(Hb)、血小板计数(Plt)、血浆组织型纤溶酶原激活物抗原性(t-PAAg)和血浆纤溶酶原激活物抑制物抗原性(PAI-1Ag)。结果t-PAAg术后72hG组(单纯全麻)t-PAAg水平显著低于E组(连续硬膜外阻滞)和G+E组(全麻复合硬膜外阻滞)(P<0.05)。PAI-1Ag在G组麻醉后PAI-1Ag高于E组和G+E组(P<0.05)。结论连续硬膜外麻醉或硬膜外麻醉复合全麻减少t-PAAg的灭活,明显抑制PAI-1Ag的分泌,有利于促进纤溶功能。

Objective： To observe and compare the changes of fibrinolysis of gastric cancer patients undergoing gastrectomy with continuous epidural anesthesia and general anaesthesia and continuous epidural anesthesia combined with general anaesthesia. Methods： Patients were randomly divided into group E （continuous epidural anesthesia ）, group E ＋ G （ continuous epidural anesthesia combined with general anaesthesia ）, group G （ general anaesthesia ）. Venous blood samples were taken for determination of blood concentration of hemoglobin and platelet, plasma concentration of tissue type plasminogen activator（t- PA） and plasminogen activator inhibitor- 1 （PAI- 1 ）. Results： At seventy - two hours after operation, the concentration of t - PA was significantly lower in group G than that in group E and group E ＋G（P〈0.05）. The level of PAI- 1 was higher after anesthesia in group G than that in group E and group E ＋ G （P 〈 0.05 ）. Conclusion： Continuous epidural anesthesia or continuous epidural anesthesia combined with general anaesthesia can inhibit the production of PAI- 1, and reduce activation of t - PA.