硬膜外麻醉复合全身麻醉对感染性休克手术患者vWF、D-D、TAT水平的影响

Effect of Epidural Anesthesia Combined with General Anesthesia on vWF, D-D and TAT Levels in Patients Undergoing Septic Shock Surgery

目的研究硬膜外麻醉复合全身麻醉对感染性休克手术患者血浆血管性血友病因子(vWF)、D-二聚体(D-D)、凝血酶-抗凝血酶复合物(TAT)水平的影响。方法选取2018年1月—2019年5月收治的拟行感染性休克手术患者114例为研究对象,根据麻醉方法分为观察组和对照组,每组57例。对照组采用全身麻醉,观察组采用硬膜外麻醉复合全身麻醉。观察2组麻醉前后收缩压、舒张压、呼吸、心率、血氧饱和度变化情况。比较2组麻醉前后外周血CD3+、CD4+、CD4+/CD8+,血清肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白介素-6(IL-6)水平,以及血浆vWF、D-D、TAT水平。观察2组不良反应发生情况。结果观察组麻醉后收缩压、舒张压、血氧饱和度、CD3+、CD4+、CD4+/CD8+水平显著高于对照组,呼吸、心率、TNF-α、CRP、IL-6、vWF、D-D、TAT水平显著低于对照组(P<0.05)。2组不良反应总发生率比较差异无统计学意义(P>0.05)。结论与全身麻醉相比,硬膜外麻醉复合全身麻醉对感染性休克患者生命体征、细胞免疫功能以及血清炎性因子水平的改善程度更好,还可降低术后血栓的发生率,且安全性较好。

Objective To investigate the effects of epidural anesthesia combined with general anesthesia on plasma levels of von Willebrand factor(vWF),D-dimer(D-D),thrombin-antithrombin complex(TAT)in patients undergoing septic shock surgery.Methods A total of 114 patients with septic shock who were treated from January 2018 to May 2019 were selected as the study subjects,and divided into observation group(n=57)and control group(n=57)according to the anesthesia method.The control group received general anesthesia,while the observation group received epidural anesthesia combined with general anesthesia.The changes of systolic blood pressure(SBP),diastolic blood pressure(DBP),respiration,heart rate(HR)and oxygen saturation(SpO 2)before and after anesthesia in the two groups were observed.The levels of peripheral blood CD3+,CD4+,CD4+/CD8+,serum tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6),plasma vWF,D-D and TAT were compared between the two groups before and after anesthesia.The occurrence of adverse reactions in the two groups was observed.Results The levels of SBP,DBP,SpO 2,CD3+,CD4+,CD4+/CD8+in the observation group were significantly higher than those in the control group,while the levels of respiration,HR,TNF-α,CRP,IL-6,vWF,D-D and TAT were significantly lower than those in the control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Compared with general anesthesia,epidural anesthesia combined with general anesthesia improved the vital signs,cellular immune function and serum inflammatory factor levels of patients with septic shock to a better extent,and reduced the incidence of postoperative thrombosis,with better safety.