全麻与腰丛坐骨神经阻滞对糖尿病截肢术患者凝血功能的影响

Effect of General Anesthesia and Lumbar Plexus Sciatic Nerve Block on Coagulation Function in Patients with Diabetes

目的:探讨用血栓弹力图(TEG)评价全麻与腰丛坐骨神经阻滞两种麻醉方法对糖尿病患者截肢术围术期凝血功能的影响。方法:选择2013年6月-2017年6月于我院接受截肢术的糖尿病患者60例,分为观察组和对照组,各30例。观察组麻醉方式采用超声引导下坐骨神经阻滞及腰大肌间隙腰丛神经阻滞,对照组麻醉方式为气管插管全麻。60例患者均在进行麻醉前、切皮后10min、手术结束后2h抽取静脉血液做TEG检测,对两组患者的TEG参数指标进行对比分析。结果:有创动脉压和心率变异性在两组病例对比分析中显示差异无统计学意义(P>0.05);对照组手术后r、k明显低于手术前和手术中,而α、MA、CI和LY30明显高于手术前和手术中,差异有统计学意义(P<0.05),而观察组明显升高的仅有参数LY30,差异有统计学意义(P<0.05);术后对照组患者的r明显低于观察组,α、MA、LY30和CI均明显高于观察组,差异有统计学意义(P<0.05);手术后对照组发生静脉血栓的比例为13.3%,观察组为3.3%,差异有统计学意义(P<0.05)。结论:腰丛坐骨神经阻滞可缓解患者血液高凝状态,有利于预防糖尿病患者截肢术围术期血栓形成,并不增加术中失血量及术后切口引流量。

Objective：To evaluate the different two types of general anesthesia and lumbar plexus-sciatic nerve block anesthesia on coagulation function in Amputation of diabetic patients using thrombelastography.Methods：A total of 60 cases from June 2013 to June 2017 in our hospital which were undergoing amputation of diabetic patients were studied,and they were randomly divided into two groups,each of 30 cases.The control group was administered with general anesthesia,the observation group was administered with nerve block anesthesia.The difference of thrombelastography parameters between the two groups were analyzed before anethesia,during operation and 2 hafter operation.Results：There was no significant difference between the two groups of invasive arterial pressure and heart rate variability（P〈0.05）.Compared with pre-surgery and surgery,the r,k decreased significantly,meanwhileα,MA,CI and LY30 in the general anesthesia group were significantly increased（P〈0.05）,and LY30 in the nerve block anesthesia group was rised significantly（P〈0.05）.when the parameters after surgery were compared in the two group,the r of nerve block anesthesia group was significantly higher,while theα,MA,LY30 and CI were lower than the general anesthesia group（P〈0.05）.Compared with 13.3% of the control group,the rate of venous thrombosis in the observation group was 3.3%,and the difference was statistically significant（P〈0.05）.Conclusion：Lumbar plexus sciatic nerve block can relieve the hypercoagulable state of patients,and prevent thrombosis during perioperative period of amputation of diabetic patients.It does not increase intraoperative blood loss and postoperative incision drainage.