静脉自控镇痛对门脉高压患者门奇静脉断流术后凝血功能的影响

Effects of patient controlled intravenous analgesia on blood coagulation function after portal-azygous disconnection in hypersplenic patients

目的探讨静脉自控镇痛(PCIA)对肝硬化门脉高压脾亢患者门奇静脉断流术后凝血功能的影响。方法测定本院2006年10月至2007年10月收治的24例肝硬化门脉高压脾功能亢进患者,摒除术后估计出血大于800ml或并发肝衰竭者。按奇偶数法随机分为PCIA组(n=12例)和对照组(未实施PCIA,n=12例)。分别于麻醉前、手术当天、术后3天、术后7天测定凝血酶原时间(PT)、凝血酶原活动度(PTa)、纤维蛋白原(FIB)及谷丙转氨酶(ALT)、白蛋白(ALB)、胆碱酯酶(CHE)。结果与对照组相比PCIA组术后3天FIB升高,术后7天PT缩短、PTa升高、FIB升高。肝功能两者无显著变化。结论PCIA可改善肝硬化门脉高压脾亢患者门奇静脉断流术后凝血功能。

Objective To evaluate the effects of patient controlled intravenous analgesia （PCIA） on blood coagulation function after portal-azygous disconnection in hypersplenic patients with liver cirrhosis. Methods Twenty-four hypersplenic patients undergoing portal-azygous disconnection were enrolled in the study, those with blood loss over 800ml or liver failure after operation were excluded. The patients were randomly divided into PCIA and control groups （n=12 each）. In the PCIA group,morphine was infused continuously with PCIA for 48 h after operation,while in control group only 75rag pethidine was injected intramuscularly, if it was necessary at operation night. Results There were significant differences in prothrombin time, prothrombin activity,fibrinogen 7 d after operation and fibrinogen 3d after operation. The hepatic function was not changed significantly. Conclusion PCIA can improve blood coagulation function after portal-azygous disconnection.