硬膜外腔吗啡对髋关节手术围术期D-二聚体的影响

The effect of epidural morphine on the D-dimer in perioperative period of hip joint surgery

目的研究髋关节手术中应用硬膜外腔吗啡持续注射对患者围术期D-二聚体的影响。方法选取中山市黄圃人民医院2018年3月至2020年3月接受全髋关节置换手术治疗患者68例,进行回顾性分析,根据不同麻醉药物及方法的不同分为吗啡组(n=34)与对照组(n=34)。术前,吗啡组患者予以硬膜外腔吗啡2 mg+0.9%生理盐水10 ml注射,对照组采用0.9%生理盐水10 ml注射。术后,观察组与对照组均施行硬膜外导管镇痛,吗啡组给予吗啡8 mg,持续48 h;对照组给予0.15%罗哌卡因2.0 ml/h,持续48 h。分别于麻醉前5 min、术毕以及术后24 h、48 h抽取静脉血,分别对两组患者的围术期凝血酶原时间以及出血量、不同时间点白细胞介素-6(IL-6)、D-二聚体含量等临床指标进行监测。结果两组患者围术期凝血酶原时间和出血量指标比较,差异无统计学意义(P>0.05);两组术后各时间点的IL-6、D-二聚体含量高于麻醉前,差异有统计学意义(P<0.05);吗啡组患者手术结束时及术后各时间点IL-6、D-二聚体含量低于对照组,差异有统计学意义(P<0.05)。结论硬膜外腔注射吗啡对凝血系统亢进以及D-二聚体生成均具有良好的抑制作用,可改善围术期高凝状态。

Objective To study the effect of continuous epidural injection of epidural morphine in hip joint surgery on the D-dimer of the patients in the perioperative period.Methods A total of 68 patients who underwent total hip arthroplasty in Huangpu People's Hospital of Zhongshan from March 2018 to March 2020 were selected and retrospectively analyzed.They were divided into the morphine group(n=34)and the control group(n=34)according to different anesthetic drugs and methods.Before surgery,the patients of the morphine group were injected 2 mg of epidural morphine plus 10 ml of 0.9%saline,while the patients of the control group were injected 10 ml of 0.9%saline.After surgery,epidural catheter analgesia was performed in both the morphine group and the control group.The patients of the morphine group were administered 8 mg of morphine for 48 h,while those of the control group were administered 0.15%ropivacaine at 2.0 ml/h for 48 h.Venous blood samples were collected at 5 min before anesthesia,immediately after surgery,24 h and 48 h after surgery,respectively.Such clinical indicators as perioperative prothrombin time(PT)and blood loss,IL-6 at different time points and D-dimer content,etc.of the two groups were monitored.Results The differences between the two groups in the indices of PT and blood loss during the perioperative period were statistically insignificant(P>0.05);the IL-6 and D-dimer content at all the time points after surgery were higher than those before anesthesia,and the differences were statistically significant(P<0.05);the IL-6 and D-dimer content of the patients in the morphine group at the end of operation and all the time points after surgery were lower than those of the control group,and the differences were statistically significant(P<0.05).Conclusion Epidural injection of morphine produces good inhibitory effect on both a ccentuation in the blood coagulation system and D-dimer formation,and it ameliorates perioperative hypercoagulability.