不同麻醉手段对全髋关节置换术后患者凝血、纤溶指标变化和安全性的影响

Effects of Different Anesthesia Methods on the Changes of Blood Coagulation,Fibrinolysis Indexes and Safety of Patients after Total Hip Arthroplasty

目的:研究观察不同麻醉手段对全髋关节置换术后患者凝血与纤溶指标变化和安全性的影响。方法:选择2017年6月-2019年10月本院收治的行全髋关节置换术治疗患者60例为研究对象,应用计算机数字随机分配原则将其分为对照组(n=30)与观察组(n=30),对照组实施全身麻醉干预,观察组实施腰硬联合麻醉干预,比较两组术后凝血、纤溶指标变化及其安全性。结果:观察组术后呼吸恢复、睁眼、拔管及定向力恢复时间均较对照组缩短,不良反应发生率大幅度降低,差异均有统计学意义(P<0.05)。两组各项凝血功能指标T0、T1、T3及T4时段相比变化均不明显,而T2时段则出现增高,且对照组各项凝血指标T2时段变化更明显,相比T0时段,差异有统计学意义(P<0.05),两组各时段凝血功能指标对比,差异均无统计学意义(P>0.05)。两组不同时段PAI-1水平比较,差异均无统计学意义(P>0.05);两组T2、T3时段t-PA、D-D比较,差异均有统计学意义(P<0.05),两组其他时段t-PA、D-D比较,差异均无统计学意义(P>0.05)。结论:全髋关节置换术治疗患者术中采用腰硬联合麻醉方式,可有效避免术后血液高凝状态,减轻对纤溶功能影响,继而保证麻醉安全性,值得在临床中推广应用。

Objective:To study the effects of different anesthesia methods on the changes of blood coagulation,fibrinolysis indexes and safety of patients after total hip arthroplasty.Method:60 patients with total hip arthroplasty in our hospital from June 2017 to October 2019 were selected as the research objects,and they were divided into the control group(n=30)and the observation group(n=30)according to the principle of computer digital random distribution.The control group was given general anesthesia intervention,and the observation group was given combined spinal and epidural anesthesia intervention.The changes of blood coagulation,fibrinolysis indexes and safety of two groups were compared.Result:The time of respiratory recovery,eye opening,extubation and orientation recovery in the observation group were shorter than those in the control group,and the incidence of adverse reactions was significantly reduced,the differences were statistically significant(P<0.05).There were no significant changes in coagulation function indexes between two groups at T0,T1,T3 and T4,but it increased at T2,the changes of coagulation indexes in the control group were more obvious at T2,compared with T0,the difference was statistically significant(P<0.05).There were no significant differences in coagulation function between two groups(P>0.05).There were no significant differences in PAI-1 level between two groups at different time points(P>0.05).There were significant differences in t-PA and D-D between two groups at T2 and T3(P<0.05).There were no significant differences in t-PA and D-D between two groups in time points(P>0.05).Conclusion:Combined spinal and epidural anesthesia used in patients with total hip arthroplasty can effectively avoid postoperative hypercoagulability,reduce the impact on fibrinolytic function,and ensure the safety of anesthesia,which is worthy of clinical application.