全身麻醉与连续硬膜外麻醉对全膝关节置换术围术期血液保护及深静脉血栓发生率的影响

Influence on perioperative blood conservation and deep vein thrombosis incidence in perioperative period of total knee arthroplasty on general anesthesia and continuous epidural anesthesia

目的 分析全身麻醉与连续硬膜外麻醉下人工全膝关节置换术（TKA）围术期血液保护及深静脉血栓发生率的影响.方法 选择2009年9月～2011年1月武警浙江总队嘉兴医院行TKA手术的患者60例,按麻醉方式不同分为全身麻醉组和硬膜外组,每组各30例.观察麻醉前即刻（T1）、麻醉后30 min （T2）、术毕（T3）、术后1 d（T4）的平均动脉压（MAP）、心率（HR）、呼吸频率（RR）和血氧饱和度（SpO2）变化,记录血小板（PLC）、纤维蛋白原（Fbg）、凝血酶原时间（PT）、活化部分凝血酶时间（APTT）等凝血指标的变化情况;并对两组深静脉血栓发生率进行分析.结果 ①两组T1～T4不同时点SpO2均未见明显变化,且两组间比较,差异也无统计学意义（P＞0.05）.两组T4时点MAP、HR均低于T3时点,硬膜外组T3时点MAP、HR水平高于T2时点,硬膜外组T2时点MAP、HR水平高于T1时点,差异均有统计学意义（P＜0.05）.②全身麻醉组T1时点PLC、Fbg、PT、APTT与硬膜外组比较,差异均无统计学意义（P＞0.05）.全身麻醉组T4时点Fbg、PT、APTT水平低于硬膜外组T4时点,差异均有统计学意义（P＜0.05）.③全身麻醉组发生深静脉血栓11例（36.7％）,明显高于硬膜外组的3例（10.0％）,差异有统计学意义（P＜0.05）.结论 采用连续硬膜外麻醉方式对降低人工全膝关节置换术后深静脉血栓的发生率效果明显.

Objective To analyze the influence on perioperative blood conservation and deep vein thrombosis incidence in perioperative period of total knee arthroplasty on general anesthesia and continuous epidural anesthesia.Methods 60 patients with total knee arthroplasty operation from September 2009 to January 2011 in Zhejiang Provincal Corps Jiaxing Hospital of Chinese People＇s Armed Police Force were selected and divided into general anesthesia group and continuous epidural anesthesia group with 30 cases in each group according to the anesthesia way.Mean arterial pressure （MAP）,heart rate （HR）,SpO2 changes in both groups at the time point of immediately before anesthesia （T1）,30 min after anesthesia （T2）,at the end of operation （T3）,1 day after operation were observed; PLC,Fbg,PT,APTT in both groups were recorded and the incidence of deep vein thrombosis in the two groups were analyzed.Results ①No changes of SpO2 were found at T1-T4 time points in the two groups and the differences between the two groups were not statistically significant （P 〉 0.05）; MAP,HR at T4 time point in the two groups were all lower than those at T3 time point; MAP,HR at T3 time point in continuous epidural anesthesia group were higher than those at T2 time point; MAP,HR at T2 time point in continuous epidural anesthesia group were higher than those at T1 time point,the differences were statistically significant （P 〈 0.05）.②The differences of PLC,Fbg,PT,APTT at each time point between general anesthesia group and continuous epidural anesthesia group were not statistically significant （P 〉 0.05）; Fbg,PT,APTT in general anesthesia group at T4 time point were lower than those in continuous epidural anesthesia group,the differences were statistically significant （P 〈 0.05）.③11 cases （36.7%） with deep vein thrombosis were found in general anesthesia group,it was higher than that in continuous epidural anesthesia group [3 （10.0%）],the difference was statistically significant （P 〈 0.05）.Conclusion Continuous epidural anaesthesia can reduce the incidence of deep vein thrombosis in patients receiving total knee arthroplasty.