不同麻醉方法对围关节置换期患者凝血标志物的影响

Effects of Different Anesthesia Methods on Coagulative Markers after Joint Arthroplasty

目的观察不同麻醉方法对围关节置换期患者凝血标志物的影响。方法选择择期行关节置换手术患者94例,按照麻醉方法不同将其分为全身麻醉组(48例)和椎管麻醉组(46例)。分别于麻醉前及术后采静脉血行血栓调节蛋白(TM)、凝血酶抗凝酶复合物(TAT)、组织型纤溶酶原激活抑制复合物(t-PAIC)、纤溶酶-抗纤溶酶复合物(PIC)、纤维蛋白降解产物(FDP)及D-二聚体等凝血标志物检测,并比较了两组患者麻醉的有效性和安全性。结果椎管麻醉组患者术后视觉模拟评分(VAS)及术后麻醉留观时间低于全身麻醉组(P<0.05);两组组内比较TM值术后较麻醉前显著降低(P<0.05),全身麻醉组组内比较TAT、t-PAIC、PIC、FDP及D-二聚体值在麻醉前及术后两个时间点均没发生显著变化(P>0.05),椎管麻醉组组内tPAIC、PIC及D-二聚体值术后较麻醉前显著降低(P<0.05);并且椎管麻醉组患者输血率及深静脉血栓发生率均显著低于全身麻醉组,差异有统计学意义(P<0.05)。结论椎管麻醉能有效的预防围关节置换期患者血液高凝状态,有利于减少围关节置换期血栓性并发症的发生。

Objective To investigate the effects of different anesthesia methods on coagulative markers after joint arthroplasty. Methods A total of 94 patients receiving joint replacement were divided by different anesthesia measures into general anesthesia group （GA, 48 cases） and vertebral canal anesthesia group （VCA, 46 cases）. Coagulative markers including thrombomodulin （TM）, thrombin anticoagulase complex （TAT）, tissue plasminogen activator inhibits complex （t-PAIC）, plasmin-antiplasmin complex （PIC）, fibrin degradation product （FDP） and d-dimer were detected before anesthesia and after postoperation by withdrawing blood from patient′s veins. Moreover, effectiveness and safety were compared between the two groups. Results VCA group had lower visual analogue scale （VAS） score and postoperative anesthesia observation time after operation than the GA group （ P 〈0.05）. Among two group the value of TM after postoperation was significantly decreased compared with before anesthesia （ P 〈0.05）. Within GA group, the values of TAT, t-PAIC, PIC, FDP and d-dimer unchanged between the two time points （ P 〉0.05）. However, within VCA group, the value of t-PAIC, PIC and d-dimer after postoperation were significantly decreased compared with before anesthesia （ P 〈0.05）.Furthermore, the blood transfusion rate and incidence of deep venous thrombosis in VCA group were significantly decreased compared with GA group （ P 〈0.05）. Conclusion Vertebral canal anesthesia will more effectively prevent rejection hepercoagulabale state on patients after joint arthroplasty, reduce thrombotic complication in preoperative period.