超声引导下星状神经节阻滞对膝关节置换围手术期凝血功能的影响

Effect of ultrasound-guided stellate ganglion block on coagulation function in patients undergoing total knee arthroplasty

目的探讨超声引导下星状神经节阻滞(SGB)对膝关节置换术患者围手术期凝血功能的影响。方法选取2019年1月至2021年1月江西省赣州市人民医院收治的66例行膝关节置换术治疗的膝关节骨关节病患者作为研究对象,按照掷硬币法分为研究组(34例)与对照组(32例)。对照组接受常规全身麻醉,研究组在此基础上联用超声引导下SGB。比较两组阻滞前、阻滞后15 min、插管时、拔管时的平均动脉压(MAP)、心率(HR)、中心静脉压(CVP);比较两组阻滞前(T0)、阻滞后60 min(T_(1))、术后24 h(T_(2))、术后48 h(T_(3))的凝血酶原时间(PT)、D-二聚体(D-D)、活化部分凝血活酶时间(APTT)、血小板计数(PLT)、血小板平均聚集率(Ara)。结果阻滞前两组的CVP、HR、MAP比较,差异无统计学意义(P>0.05);阻滞后15 min研究组的CVP、HR、MAP低于对照组,差异有统计学意义(P<0.05);插管时、拔管时研究组的CVP、HR低于对照组,MAP高于对照组,差异有统计学意义(P<0.05)。T0时两组的PT、D-D、APTT、PLT、Ara比较,差异无统计学意义(P>0.05);T_(1)、T_(2)、T_(3)时研究组的PT、APTT长于对照组,D-D、PLT、Ara低于对照组,差异有统计学意义(P<0.05)。结论超声引导下SGB可降低麻醉药物对膝关节置换术患者循环功能的影响,改善患者术后凝血功能,降低血管性栓塞发生风险。

Objective To investigate the effect of ultrasound-guided stellate ganglion block(SGB)on coagulation function in patients undergoing knee arthroplasty.Methods From January 2019 to January 2021,66 patients with knee osteoarthropathy treated by knee arthroplasty in Ganzhou people′s Hospital of Jiangxi Province were selected as the research objects.According to the coin toss method,they were divided into the research group(34 cases)and the control group(32 cases).The control group received conventional general anesthesia,and the research group was combined with ultrasound-guided SGB.The mean arterial pressure(MAP),heart rate(HR)and central venous pressure(CVP)before block,15 min after block,during intubation and extubation were compared between the two groups;Prothrombin time(PT),D-Dimer(D-D),activated partial thromboplastin time(APTT),platelet count(PLT)and average platelet aggregation rate(ARA)were compared between the two groups before block(T0),60 min after block(T_(1)),24 h(T_(2))and 48 h(T_(3)).Results There was no significant difference in CVP,HR and MAP between the two groups before block(P>0.05).The CVP,HR and MAP of the study group were lower than those of the control group at 15 min after block,the differences were statistically significant(P<0.05).During intubation and extubation,CVP and HR of the study group were lower than those of the control group,while MAP of the study group was higher than that of the control group,the differences were statistically significant(P<0.05).There was no significant difference in PT,D-D,APTT,PLT and Ara between the two groups at T0(P>0.05).At T_(1),T_(2) and T_(3),PT and APTT in the study group were longer than those in the control group,while D-D,PLT and Ara in the study group were lower than those in the control group the differences were statistically significant(P<0.05).Conclusion Ultrasound guided SGB can reduce the influence of anesthetics on circulation function,improve postoperative coagulation function and reduce the risk of vascular embolism.