全麻和硬膜外麻醉对高龄全膝关节置换患者凝血功能的影响

Effect of General Anesthesia and Epidural Anesthesia on Coagulation Function in Elderly Patients Undergoing Total Knee Arthroplasty

目的 观察高龄全膝关节置换患者行全麻和硬膜外麻醉术后凝血功能变化情况.方法 选取武威市凉州医院2015年9月-2016年11月收治的83例行全膝关节置换的高龄患者,随机分为观察组（硬膜外麻醉）和对照组（全身麻醉）,比较两组患者在围手术期间凝血功能指标变化情况,统计术后下肢深静脉血栓发生情况.结果 两组患者入院时凝血功能指标差异无统计学意义（P＞0.05）;麻醉后6h、术后1d观察组活化部分凝血活酶时间、D-二聚体水平高于对照组,差异有统计学意（P＜0.05）;对照组下肢深静脉血栓发生率高于观察组,差异有统计学意（P＜0.05）.结论 对于高龄全膝关节置换患者,选择硬膜外麻醉能有效维持机体凝血功能状态平稳,避免下肢深静脉血栓的发生.

Objective To observe the changes of blood coagulation function after general anesthesia and epidural anesthesia in elderly patients undergoing total knee arthroplasty （TKA）. Methods A total of 83 elderly patients undergoing total knee arthroplasty were recruited in our hospital from September 2015 to November 2016. All patients were randomly divided into two groups： observation group （epidural anesthesia） and control group （general anesthesia）. We compared the blood coagulation functions in perioperative period, and evaluated the occurrence rate of deep venous thrombosis （DVT） between two groups. Results There was no significant difference in coagulation function between two groups on admission （P〉0.05）. Activated partial thromboplastin time （APTT） and D-dimer levels at 6 hours after anesthesia and 1 day after operation in observation group were significantly higher than those in control group （P〈0.05）. The incidence rate of deep venous thrombosis in control group was significantly higher than those in observation group （P〈0.05）. Conclusion Epidural anesthesia can effectively maintain the coagulation function and prevent the occurrence of deep vein thrombosis in the elderly patients undergoing TKA.