不同麻醉方法对老年股骨手术患者围术期卒中高危因素的影响

Effect of different anesthesia methods on peri-operative stroke risk factors for elderly patients with femoral operation

目的探讨不同麻醉方法对老年股骨手术患者围手术期卒中高危因素的影响。方法选取116例择期进行股骨手术的老年患者,随机分2组,对照组58例采用单纯全麻进行手术,实验组58例采用全麻复合硬膜外麻醉手术。观察麻醉诱导前后、手术前后2组老年患者的抗凝参数含量、纤溶参数D-二聚体含量以及手术前后神经功能评分。结果麻醉诱导前、诱导后、手术结束时、术后72h,实验组凝血酶抗凝血酶复合物水平均明显低于对照组(P<0.05);实验组D-二聚体水平与对照组无显著性差异(P>0.05)。2组手术前神经功能评分差异无统计学意义(P>0.05),术后实验组神经功能明显高于对照组(P<0.05)。结论全麻复合硬膜外麻醉有利于降低老年股骨手术患者围手术期血小板活化,降低高凝状态,对纤溶状态无明显影响,对降低围手术期卒中高危因素有一定临床意义。

Objective To investigate the effect of different surgical anesthesia on peri-operative stroke risk factors in elderly patients with femoral operation.Methods 116 elderly patients with surgical treatments on femoral were randomly divided into control group（n=58）and trail group（n=58）,and patients in control group were given general anesthesia for surgery,patients in trail group were treated with general anesthesia combined with epidural anesthesia.Anticoagulation parameters content,fibrinolytic parameters D-dimer,limb function score were observed before and after induction of anesthesia.ResultsThrombin-antithrombin complex in trail group was lower than control group（P〈0.05）before induction of anesthesia,after induction,at the end of surgery,and after 72 hours.D-dimer was not different between two groups（P〈0.05）.Limb function score was not different between two groups（P〈0.05）before induction of anesthesia,limb function score in trail group patient was higher than that of control group（P〈0.05）.Conclusion General anesthesia combined with epidural anesthesia in elderly patients with femoral operation can reduce peri-operative platelet activation,reduce hypercoagulable state,with no significant effect on fibrinolysis,and has some clinical significance on reducing peri-operative stroke risk factors.