不同麻醉方法对老年全髋关节置换术患者术后深静脉血栓形成的影响

Effects of Different Anesthesia Methods on Postoperative deep Venous Thrombosis in Elderly Patients Undergoing Total hip Arthroplasty

目的研究不同麻醉方法对老年全髋关节置换术患者术后(DVT)的影响。方法选取我院2014年6月至2016年6月行全髋关节置换术的老年患者82例,根据麻醉方式的不同将患者分为全麻组和硬膜外麻醉组,每组41例,比较两组患者围术期相关指标、DVT发生率及血小板(PLT)、纤维蛋白原(Fbg)、凝血酶原时间(PT)、凝血酶时间(TT)等凝血指标水平变化,比较两组患者手术前后血液流变学变化。结果术后1 d全麻组患者全血低切黏度、全血高切黏度、血浆黏度、红细胞比积、Fbg水平较硬膜外麻醉组均显著较高(P<0.05),红细胞变形能力较硬膜外麻醉组显著较低(P<0.05);全麻组患者PLT、Fbg水平较硬膜外麻醉组显著较高(P<0.05),PT、TT水平较硬膜外麻醉组显著较低(P<0.05);全麻组患者全髋关节置换术后发生DVT的概率为39.02%显著高于硬膜外麻醉组7.32%(P<0.05)。结论全髋关节置换术中应用硬膜外麻醉能降低术后DVT的发生率,且硬膜外麻醉不会对患者的血液流变学造成明显影响。

Objective To study the effects of different anesthesia methods on postoperative deep venous thrombosis（DVT） in elderly patients undergoing total hip arthroplasty. Methods 82 cases of elderly patients in our hospital from June 2014 to June 2016 for total hip replacement, according to the different methods of anesthesia, the patients were divided into general anesthesia group and epidural anesthesia group, 41 cases in each group, compared two groups of patients with peri operation period related indicators, the incidence of DVT and platelet （ PLT）, fibrinogen （Fbg） prothrombin time （ PT）, thrombin time （TY） changes of coagulation function, hemorheology before and after surgery were compared between the two groups. Results After l d anesthesia group with low blood viscosity, whole blood viscosity, plasma viscosity, hematocrit, Fbg levels than the epidural anesthesia group were significantly higher （ P 〈 0.05 ） , red blood cell deformability than epidural anesthesia group was significantly lower（ P 〈 0. 05 ） ;group PLT, general anesthesia the level of Fbg was significantly higher than epidural anesthesia group （ P 〈 0. 05 ） , PT, TY levels were significantly lower in epidural anesthesia group （ P 〈 0. 05 ） ; the incidence of DVT in patients with general anesthesia group after total hip arthroplasty was 39.02% significantly higher than that of the epidural anesthesia group（ P 〈 0. 05 ） 7.32%. Conclusion Epidural anesthesia can reduce the incidence of postoperative DVT in total hip arthroplasty, and epidural anesthesia has no significant effect on hemorheology.