七氟醚及丙泊酚对老年结肠癌患者术后血栓风险的影响

目的探讨七氟醚与丙泊酚对老年结肠癌患者凝血功能、血流动力学的影响，分析术后血栓发生率。方法2015年8月至2017年8月老年结肠癌患者150例，均行结肠癌根治术。随机分为七氟醚组、丙泊酚组，各75例，七氟醚组采用吸入麻醉，丙泊酚组采用静脉麻醉。比较两组麻醉前（TO）、诱导后2min（T1）、插管后1min（T2）、术毕即刻（T3）的凝血功能、血流动力学变化情况，并记录术后深静脉血栓发生率。其中凝血功能指标包括包括D-二聚体（D-D）、纤维蛋白原（FIB）、内皮素－1（ET-1）、血浆血栓素B2（TXB2），血流动力学指标平均动脉压（MAP）、体循环血管阻力（SVR）、心输出量（CO）、左室做功（LCW）。结果两组TO时凝血功能指标比较差异无统计学意义（P〉0．05），两组T1、T2、T3时的血清D-D、ET-1、TXB2、FIB水平高于TO，差异有统计学意义（P〈0．05），丙泊酚组T3时血清D-D、ET-1、TXB2、FIB高于七氟醚组，差异有统计学意义（P〈0．05）；两组TO时各血流动力学指标比较，差异无统计学意义（P〉0.05），两组T1、T2、T3时MAP、SVR、LCW显著低于T0，T2、T3时的CO显著低于T0（P〈0．05），丙泊酚组T3时MAP、CO低于七氟醚组，差异有统计学意义（P〈0．05）。结论与丙泊酚相比，七氟醚能减轻手术对老年结肠癌患者术中凝血功能、血流动力学的影响，降低术后深静脉血栓发生率，值得临床推广。

Objective To investigate the effect of sevoflurane and propofol on blood coagulation and hemodynamics in elderly patients with colon cancer, and to analyze the incidence of thrombus after operation. Methods A total of 150 elderly patients with colon cancer treated in our hospital from August 2015 to August 2017 were treated with radical resection of colon cancer.It was randomly divided into 75 cases of sevoflurane group and propofol group, and sevoflurane group was induced by inhalation anesthesia, and propofol group was anesthetized by intravenous anesthesia.The changes of blood coagulation and hemodynamics were compared between And the incidence of deep venous thrombosis was recorded after operation. The indexes of coagulation function included D-two polymer （ D-D ） , fibrinogen （ FIB ） , endothelin-1 （ ET- 1 ） , and plasma thromboxane B2 （ TXB2 ） .The bemodynamic indexes were mean arterial pressure （ MAP ） , systemic vascular resistance （ SVR ） , cardiac output （ CO ） , and left ventricular work （ LCW ） .Results There was no significant difference in the index of coagulation function between the two groups of T0 （P〉0.05） .The levels of serum D-D, ET-1, TXB2 and FIB in the two groups of T1, T2 and T3 were higher than those ofT0, and the difference was statistically significant （ P〈0.05 ） .The serum D-D, ET-1, TXB2 and FIB in the propofol group T3 were higher than those in the sevoflurane group, and the difference was significant （ P〈0.05 ） .There was no statistical significance in the hemodynamic indexes of the two groups of T0 （ P〉0.05 ） .The two groups of MAP, SVR, and LCW at T1, T2 and T3 were significantly lower than TO, T2 and T3 were significantly lower than T0 （ P〈0.05 ） .The MAP and CO in the propofol group T3 were lower than the sevoflnrane group, and the difference was statistically significant （ P〈0.05 ） . Conclusion Compared with propofol, sevoflurane can reduce the influence of operation on coagulation function and hemodynamics in elderly patients with colon cancer, and reduce the incidence of deep vein thrombosis after operation, which is worthy of clinical promotion.