全麻及全麻复合硬膜外麻醉对胃癌手术患者凝血功能的影响对比

Comparison of Effect of General Anesthesia and General Anesthesia combined with Epidural Anesthesia on Coagulation Function of Patients with Gastric Cancer Surgery

目的：探讨全麻及全麻复合硬膜外麻醉对胃癌手术患者凝血功能的影响。方法：选择2013年1月-2015年12月我院收治的60例胃癌根治术患者，随机均分为全麻组（A组）及全麻复合硬膜外麻醉组（B组）。对比两组患者的术后恢复情况、T0（术前）、T1（术毕）、T2（术后24h）、T3（术后72h）的血浆纤维蛋白原（FIB）、凝血酶时间（TT）、血浆凝血酶原时间（PT）、部分活化凝血酶时间（APTT）、血小板计数（PLT）及血检素B2（TXB2）值。结果：B组的清醒时间、自主呼吸恢复时间、拔管时间及异丙酚维持麻醉用量明显低于A组（P分别为0．044、0．036、0．042）；与T0相比，B组PT、APTT在T2、T3时明显延长（P〈0．05），A组及B组的FIB在T2、T3时明显升高（P〈0．05），而B组明显低于A组（P〈0．05）；与T0相比，两组PLT在T2、T3点时明显降低（P〈0.05），且A组明显低于B组（P〈0．05）；两组TXB2在T2、T3点时明显升高（P〈0．05），且A组明显高于B组（P〈0．05）。结论：全麻复合硬膜外麻醉效果确切，可以减少对患者凝血系统的影响，预防术后血栓性疾病的发生，值得临床推广应用。

Objective： To compare the influence of general anesthesia and general anesthesia combined with epidural anesthesia on coagulation function of patients with gastric cancer surgery. Methods： 60 cases with gastric cancer surgery from January 2013 to December 2015 in our hospital were chosen and randomly divided into general anesthesia group （A group）and general anesthesia combined with epidural anesthesia（B group）. The recovery condition after operation, FIB, TT, PT, APTT, PLT and TXB2 of two groups at T0（preoperative）, T1 （postoperative）, T2（after surgery for 24 h）, T3（after surgery for 72 h） were compared. Results： The waking hours, spontaneous breathing recovery time, extubation time and propofol maintained anesthesiology dosage of B group were obvious lower than those of A group （P=0.044, 0.036, 0.042）. Compared with TO, the PT and APTT at B group at T2, T3 were obviously prolonged （P〈0.05）; and the FIB of two groups at T2, T3 were increased （P〈0.05）, and it was obviously lower in B group than that of A group （P〈0. 05）. The PLT level of two groups at T2, T3 were reduced （P〈0.05）, and it was obviously lower in A group than that of B group （P〈0.05）. The TXB2 of two groups at T2, T3 were increased, and it was obviously higher in A group than that of B group （P〈0.05）. Conclusions： General anesthesia combined with epidural anesthesia has great efficacy, which can reduce the influence of coagulation system and prevent the postoperative thrombosis formation, worth of clinical promotion and application.