三种不同麻醉方式对股骨闭合骨折患者血栓弹力图的影响

The influence of three different anesthesia in thromboelastography of patients with closed fractures of the femur

目的比较腰麻(蛛网膜下腔麻醉和脊椎麻醉)、全静脉复合麻醉和静吸复合全麻对股骨闭合骨折患者麻醉手术中血栓弹力图(thromboelastogram,TEG)的影响。方法选择股骨闭合骨折,择期行股骨骨折切开复位内固定术的患者90例,年龄20～45岁,ASAⅠ级～Ⅱ级,随机等分为3组。I组为腰麻,Ⅱ组为全静脉复合麻醉,Ⅲ组为静吸复合全身麻醉。3组患者均分别于麻醉前(T0)、麻醉后30min(T1)、手术麻醉结束后(T2)静脉采血进行TEG检测。结果 (1)3组组内T1与T0比较TEG各参数间差异均无统计学意义。(2)Ⅲ组中T2分别与T0及T1比较,MA和G值缩小,差异均有统计学意义(P<0.05)。(3)Ⅲ组分别与Ⅱ组和Ⅰ组比较,出现T2的MA和G值缩小,差异有统计学意义(P<0.05)。结论 (1)三种不同的麻醉方式对股骨闭合骨折患者术中的凝血功能没有影响。(2)七氟醚吸入维持麻醉可能会改善骨折患者麻醉手术中的高凝状态。

Objective To compare the thromboelastography（TEG） of spinal anesthesia,total intravenous anesthesia and inhalation combined anesthesia in patients with closed fractures of the femur.Methods 90 patients with closed femur fracture,aged 20 to 45 years old,ASA Ⅰ-Ⅱ grade level were enrolled into this trial,and they were randomly divided into 3 groups.The group Ⅰunderwent spinal anesthesia,groupⅡ underwent total intravenous anesthesia,and group Ⅲ underwent inhalation anesthesia.The venous blood were collected for TEG test at the following time points：before anesthesia（T0）,30min after anesthesia（T1） and after surgery（T2）.Results（1）Compared with T0 and T1,TEG parameters showed no significant difference.（2）T2 compared with T0 and T1,respectively,MA and G levels decreased obviously in group Ⅲ（P0.05）.（3）Group Ⅲ compared with group I and groupⅡ,respectively,MA and G levels decreased obviously（P0.05）.Conclusion Three different ways of anesthesia in patients with closed fractures of the femur surgery had no effect on coagulation.Sevoflurane anesthesia may improve the hypercoagulability of patients with fractures.