不同麻醉方式对骨科围术期血液保护与深静脉血栓发生情况探析

Analysis of Perioperative Blood Protection and Deep Venous Thrombosis in Orthopedic Department by Different Anaesthesia Methods

目的对骨科患者实施全身麻醉、连续硬膜外麻醉方式,探讨不同麻醉方式对患者围术期血液保护及深静脉血栓发生情况的影响,旨在指导临床合理选择麻醉方案。方法回顾性分析2018年3月-2019年2月广州市番禺区中心医院收治的60例骨科手术患者病例资料,将术中接受全身麻醉的30例患者纳入对照组,将术中接受连续硬膜外麻醉的30例患者纳入对照组。于麻醉后30 min,通过全自动血凝仪测定两组血小板(BPC)、纤维蛋白原(Fbg)、凝血酶原时间(PT)及凝血酶时间(TT),比较两组手术相关指标(手术时间、麻醉时间及术中出血量)及术后1 d内深静脉血栓发生情况。结果麻醉后观察组BPC(201.55±63.94)×10^9/L、Fbg(3.06±0.59)g/L均低于对照组BPC(286.17±70.36)×10^9/L、Fbg(4.15±0.92)g/L,PT(15.89±1.64)s、TT(23.41±2.76)s均长于对照组的(12.37±1.51)s、(18.14±2.05)s,差异有统计学意义(P<0.05);观察组术后深静脉血栓发生率10.00%(3/30)低于对照组36.67%(11/30),差异有统计学意义(P<0.05);两组术中出血量、手术及麻醉时间相比,差异均无统计学意义(P>0.05)。结论与全身麻醉相比,连续硬膜外麻醉用于骨科围术期中,可起到更高的血液保护作用,改善凝血功能,减少术后深静脉血栓的发生,加快术后恢复进程,且麻醉效果显著,具有临床推广价值。

Objective To investigate the effects of general anesthesia and continuous epidural anesthesia on perioperative blood protection and deep venous thrombosis in orthopedic patients, in order to guide the rational choice of anesthesia in clinic.Methods The data of 60 patients undergoing orthopaedic surgery in the hospital from March, 2018 to February, 2019 were analyzed retrospectively. 30 patients undergoing general anesthesia during operation and 30 patients undergoing continuous epidural anesthesia were included in the control group. Platelet(BPC), proto-(Fbg), prothrombin time(PT) and thrombin time(TT)(operation time, anaesthesia time and intraoperative blood loss) and the occurrence of deep venous thrombosis within 1 day after operation were compared between the two groups. Results After anesthesia, BPC(201.55±63.94)× 10^9/L, FBG(3.06 ±0.59)g/L in the observation group were lower than those in the control group [Fbg(286.17±70.36)× 10^9/L, FBG(4.15 ±0.92 g/L]. PT(15.89±1.64)s and TT(23.41 ±2.76) s were longer than those in the control group [(12.37±1.51)s,(18.14 ±2.05)s], the incidence of deep venous thrombosis in the observation group was 10.00%(3/30), which was significantly lower than that in the control group(36.67%, 11/30). There was statistically significant difference(P<0.05). But there was no significant difference in the amount of intraoperative bleeding, operation and anesthesia time between the two groups(P>0.05). Conclusion Compared with general anesthesia, continuous epidural anesthesia can play a higher role in protecting blood, improving coagulation function and reducing coagulation during perioperative period of orthopaedics. Less postoperative deep venous thrombosis, accelerated postoperative recovery, and the anaesthetic effect was significant, which was of clinical popularization value.