全身麻醉联合硬膜外麻醉对胃癌合并高血压患者腹腔镜术后深静脉血栓形成的影响研究

Effects of General Anesthesia Combined with Epidural Anesthesia on Deep Vein Thrombosis after Laparoscopic Surgery in Patients with Gastric Cancer Complicated with Hypertension

目的:探讨全身麻醉联合硬膜外麻醉对胃癌合并高血压患者腹腔镜术后深静脉血栓形成的影响,为胃癌合并高血压患者行腹腔镜手术治疗的麻醉方案的选择提供一定的理论依据。方法:选取2015年3月-2018年6月本院收治的98例胃癌合并高血压患者,依据不同麻醉方式将其分为研究组和对照组,每组49例。对照组给予常规全麻,研究组在对照组基础上联合硬膜外麻醉。比较两组麻醉诱导前、麻醉诱导后、手术开始后30 min、术后2 h动脉收缩压(SBP)、动脉舒张压(DBP)、心率(HR)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT),凝血酶凝固时间(TT),纤维蛋白原(FIB)。比较两组术后7 d下肢深静脉血栓发生率及并发症发生情况。结果:研究组麻醉诱导后,手术开始后30 min及术后2 h的SBP、DBP及HR与麻醉诱导前比较,差异均无统计学意义(P>0.05)。麻醉诱导后,手术开始后30 min及术后2 h,研究组SBP、DBP及HR均低于对照组(P<0.05)。研究组麻醉诱导后及术后2 h的APTT、PT、TT及FIB与麻醉诱导前比较,差异均无统计学意义(P>0.05)。对照组麻醉诱导后及术后2 h的APTT及PT均低于麻醉诱导前与研究组(P<0.05)。术后7 d,研究组下肢深静脉血栓发生率为10.2%,低于对照组的30.5%(P<0.05);研究组肺部感染率为2.0%,低于对照组的18.4%(P<0.05)。结论:全身麻醉联合硬膜外麻醉可减少胃癌合并高血压患者腹腔镜术后下肢深静脉血栓发生率,生理指标稳定,建议首选。必须常规全麻者,应提前给予预防性治疗措施以降低下肢深静脉血栓形成。

Objective:To investigate the effect of general anesthesia combined with epidural anesthesia on deep vein thrombosis after laparoscopic surgery in patients with gastric cancer complicated with hypertension,and to provide a theoretical basis for the selection of anesthesia plan for laparoscopic surgery in patients with gastric cancer complicated with hypertension.Method:A total of 98 patients with gastric cancer complicated with hypertension admitted to our hospital from March 2015 to June 2018 were selected.They were divided into study group and control group according to different anesthesia methods,49 cases in each group.The control group was given routine general anesthesia,and the study group was combined with epidural anesthesia on the basis of the control group.The systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin coagulation time(TT)and fibrinogen(FIB)were compared between the two groups before and after anesthesia induction,30 min after the start of surgery,and 2 h after surgery.The incidence of lower extremity deep vein thrombosis and complications were compared between the two groups 7 d after surgery.Result:SBP,DBP and HR in the study group after anesthesia induction,30 min after the start of surgery and 2 h after surgery were compared with those of before anesthesia induction,the differences were not statistically significant(P>0.05).After anesthesia induction,30 min after the start of surgery and 2 h after surgery,SBP,DBP and HR of the study group were lower than those of the control group(P<0.05).APTT,PT,TT and FIB in the study group after anesthesia induction and 2 h after surgery were compared with those before anesthesia induction,the differences were not statistically significant(P>0.05).APTT and PT in the control group after anesthesia induction and 2 h after surgery were lower than those of before anesthesia induction and those in the study group(P<0.05).7 d after surgery,the incidence of deep venous thrombosis in the study group was 10.2%,it was lower than 30.5%in the control group(P<0.05).The pulmonary infection rate in the study group was 2.0%,it was lower than 18.4%in the control group(P<0.05).Conclusion:General anesthesia combined with epidural anesthesia can reduce the incidence of lower extremity deep vein thrombosis in patients with gastric cancer complicated with hypertension after laparoscopy,and the physiological indexes are stable,which is recommended as the first choice.Prophylaxis should be given in advance to reduce deep venous thrombosis in the lower extremities for those who must undergo routine general anesthesia.