胸段硬膜外镇痛对胸科手术患者凝血-纤溶动态平衡的影响

Effect of thoracic epidural analgesia on coagulation and fibrinolysis dynamic balance in patients undergoing major thoracic surgery

目的:用凝血-纤溶动态图(Coagulation-fibrinolysis dynamic-pattern,CF)观察胸段硬膜外镇痛(Thoracic epidural analgesia,TEA)对胸科手术患者凝血-纤溶动态平衡的影响。方法:选择开胸手术(食管癌根治术和肺叶切除术)患者40例,随机分为全麻复合硬膜外镇痛(General-epidural anesthesia,GEA)组和全麻(General anaesthesia,GA)组(n=20)。分别于麻醉诱导前(基础值)、关胸时、术后1、3 d晨空腹抽取前臂静脉血测血小板计数(Platelet,PLT)、纤维蛋白原(Fibrinogen,FIB)及凝血-纤溶动态描记图,并于术前及术后4～7 d分别行下肢深静脉彩超检查。结果:两组FIB、凝固启动时间(Concretion startup time,CST)、最大凝固程度(Maximum extent of coagulation,MCE)差异无统计学意义(P>0.05);在关胸及术后,GEA组较GA组的凝血达峰值时间(Maximum coagulation time,MCT)明显延长(P<0.05),PLT明显减少(P<0.01),平衡时间(Balance time,BLT)和全反应时间(Whole time of fibrinolysis reaction,WFT)明显缩短(P<0.01);术后下肢深静脉血栓(Deep venous thrombosis,DVT)发生率明显降低(P<0.05)。结论:TEA可抑制开胸手术后应激引起的凝血功能增强,改善术后纤溶抑制,维持体内凝血-纤溶功能的动态平衡。

Objective： To evaluate the effect of thoracic epidural analgesia（TEA） on coagulation and fibrinolysis dynamic balance in patients undergoing thoracic surgery in perioperative period by means of coagulation and fibrinolysis dynamic-pattern （ CF ）. Methods ： Forty patients undergoing thoracotomy （esophageal cancer radical correction and lobectomia pulmonalis ） were randomized to receive either combined general-epidural anesthesia（ GEA group, n=20 ） or general anesthesia（ GA group, n=20 ）. The fasting antebrachial venous blood of patients were drawn before anesthesia （basic value ）, at closing chest and on the 1 st and 3rd day after operation respectively to measure Platelet（PLT）, Fibrinogen （FIB） and make coagulation and fibrinolysis dynamic-pattern, and deep venous color doppler ultrasonoscope was done before operation and on the 4th to 7th days after operation respectively. Results： FIB, concretion startup time （CST） and maximum extent of coagulation（ MCE ） had no significant difference between the two groups （P〉0.05）. At closing chest and after operation, compared with GA group maximum coagulation time （MCT） of GEA group obviously extended（P〈0.05 ）, PLT was significantly decreased（P〈0.01 ）, the balance time （BLT） and the whole time of fibrinolysis reaction （WFT） were obviously shortened （P〈0.01）. The formation rate of postoperative deep venous thrombosis （DVT） of GEA group was significantly lower than that of GA group （P〈0.05）. Conclusion： TEA can inhibit increase in coagulation induced by stress, improve postoperative inhibition of fibrinolysis, and keep intracorporal coagulation and fibrinolysis dynamic balance.