血栓弹力图在蛛网膜下腔阻滞麻醉剖宫产中对产妇凝血功能的影响分析

Analysis of the effect of TEG on the blood coagulation function in puerpera undergoing cesarean section with subarachnoid anesthesia

目的采用血栓弹力图(TEG)评价蛛网膜下腔阻滞麻醉剖宫产中对产妇凝血功能的影响,评价麻醉、手术利弊,总结凝血功能管理经验。方法 2015年2月~2016年2月,选取牡丹江医学院第二附属医院产科行计划性剖宫产采用蛛网膜下腔阻滞麻醉手术产妇700例,分别在麻醉前、麻醉1 h采上下肢静脉血进行TEG检测,进行对比。结果完成研究674例。麻醉前,上肢R高于下肢,上肢A、CI低于下肢,差异有统计学意义(P<0.05)。麻醉1 h后,上肢K低于下肢,上肢MA、CI高于下肢,差异有统计学意义(P<0.05)。麻醉1 h后,上肢R、K低于麻醉前,上肢A、MA、CI高于麻醉前,下肢MA低于麻醉前,差异有统计学意义(P<0.05)。结论妊娠会导致上下肢凝血状态差异;麻醉与手术会影响上下肢凝血状态,对上肢影响更显著。

Objective To evaluate the effect of TEG on the blood coagulation function in puerpera undergoing cesarean section with subarachnoid anesthesia,and to evaluate the advantages and disadvantages of anesthesia and operation,and to summarize the coagulation function management experience.Methods From February 2015 to February 2016,700 puerperae schedule for cesarean section with subarachnoid anesthesia in Department of Obstetrics of the Second Affiliated Hospital of Mudanjiang Medical University were selected.TEG detection was conducted with venous blood upper and lower limbs to compare before anesthesia and after 1 h of anesthesia.Results 674 patients completed the study.Before anesthesia,R of the upper limbs was higher than that of lower limbs,A,Ci of upper limbs was lower than those of the lower limbs,and the difference was statistically significant （P〈0.05）.After 1 h of anesthesia,K of the upper limbs was lower than that of upper limbs,A,MA,CI of upper limbs was higher than of lower limbs,and the difference was statistically significant （P〈0.05）.After 1 h of anesthesia,R,K of upper limbs was lower than before anesthesia,the upper limb A,MA,CI was higher than that before anesthesia,MA of the lower limbs than before anesthesia,the difference was statistically significant （P〈 0.05）.Conclusion Pregnancy can cause the change of blood coagulation of upper limbs and lower limbs,anesthesia and operation will affect the blood coagulation of the upper and lower limbs,and the upper limb is more significant.