腰硬联合麻醉下输入不同种类液体对剖宫产产妇血栓弹力图和血小板微颗粒影响

The Effects of Different Liquid Injection to Parturient of Cesarean Section Under Combined Spinal and Epidural Anesthesia on Thromboelastography and Microparticles

目的用血栓弹力图(TEG)和血小板微颗粒(PMP)检测观察腰硬联合麻醉下快速输入不同种类液体对剖宫产产妇凝血功能的影响。方法选择在我院分娩的孕36～40周选择性剖宫产的产妇120例,随机分组3组,分别快速输入相应的液体:①平衡液;②琥珀酰明胶(血定安);③羟基淀粉。3组病人均选择腰硬联合麻醉,分别于麻醉前、手术切皮之前和术毕后30 min内,进行TEG和PMP检测。结果平衡液组R值和K值术后比术前显著减小(P<0.05),Angle值术后比术前显著增加(P<0.01),CI指数明显增加(P<0.05);血定安组MA(mm)术中和术后分别明显减少(P<0.05);羟基淀粉组K值比平衡液组增加(P<0.05);血定安组(mm)Angle(°)比平衡液组减小(P<0.05);羟基淀粉组Angle(°)值比平衡液组明显减小(P<0.01);血定安组(mm)CI值比平衡液组减小(P<0.05);羟基淀粉组CI值比平衡液组明显减小(P<0.01)。血小板计数和血小板微颗粒检验结果显示3组血小板微颗粒均无显著变化(P>0.05),3组血小板均比术前减少(P<0.05)。结论术前不同种类液体快速扩容,两组胶体液对产妇的高凝状态有一定稀释作用,对预防术后静脉血栓形成可能有一定的作用,而平衡液无此作用。3组剖宫产产妇凝血功能指标仍在正常范围。

Objective To evaluate the effects of different liquid injection to parturient of cesarean sec- tion under combined spinal and epidural anesthesia on blood coagulation function by thromboelastography and platelet particle detection. Methods 120 cases of selective cesarean section during the pregnancy of 36 - 40 weeks in our hospital were enrolled and randomized to three groups by quickly injecting the different liquids respectively that were equilibrium liquid, succinylated gelatin and hydroxyl starch. The cases in three groups were all selected for combined spinal-epidural anesthesia and their TEG and PMP were detected before anes- thesia （ preoperative）, before operation incision （intraoperative） and after operation in 30 min （ postoperative ）. Results In group which were injected by equilibrium solution, R and K value of preoperative was significant- ly shorter than postoperative （ P 〈 0.05 ）, while Angle value （ P 〈 0.01 ） and CI index （ P 〈 0.05 ） were signifi- cantly increased. In group which were injected by gelofusine, MA （mm） of intraoperative and postoperative were significantly reduced （ P 〈 0.05 ）. K value of hydroxyl setting powder group were longer than equilibrium solu- tion group（ P 〈 0.05 ）, Angle （ ° ） and CI values of gelofusine group （ P 〈 0.05 ） and hydroxyl setting powder group（P 〈0.01 ）were shorter than equilibrium solution group. Furthermore,the platelet count of three groups of intraoperative and postoperative were lower than the preoperative while the platelet count and platelet micro-particle inspection of three groups showed no significant differences （P 〉 0. 05 ）. Conclusion The maternal blood coagulation index of three groups were still within the normal range. Two groups of colloidal solution ex- cept the equilibrium liquid on maternal for rapid expansion before anesthesia had a dilution effect for hyperco- agulability and may prevent postoperative venous thrombosis.