异丙酚静脉麻醉对大面积烧伤患者凝血功能和血小板聚集的影响
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摘要
目的探究在大面积烧伤患者中使用异丙酚静脉麻醉对患者凝血功能及血小板聚集的影响。方法纳入笔者研究小组所在医院大面积烧伤患者60例,根据麻醉方式不同分为两组,观察组采用异丙酚静脉麻醉,对照组采用氯胺酮静脉麻醉。对比两组不同时间血小板[Ca~(2+)]i、血小板聚集率、凝血指数和凝固时间的变化。结果术中30min、120 min和停药60 min时观察组血小板聚集率及血小板[Ca~(2+)]i降低,且低于对照组;在上述时间段中对照组各指标明显升高。术中30 min至停药60 min时凝血指数低于对照组,凝固时间长于对照组;对照组术中120 min至停药60 min凝血指数较麻醉诱导前高,凝固时间在术中60 min至停药60 min较麻醉诱导前短(P均<0.05)。结论大面积烧伤患者应用异丙酚静脉麻醉能降低血小板[Ca~(2+)]i,抑制血小板聚集,缓解术中高凝状态。
Objective To explore the effect of propofol intravenous anesthesia on coagulation function and platelet aggregation in patients with extensive burns. Methods 60 cases of patients with extensive burns in the hospital of our research group were selected and divided into two groups( observation group and control group) according to different anesthesia methods.The observation group were given propofol intravenous anesthesia,while the control group were given ketamine intravenous anesthesia.And then,the changes of platelet[Ca~(2+)]i,platelet aggregation rate,coagulation index and coagulation time were compared between the two groups at different times.Results The platelet aggregation rate and platelet[Ca~(2+)]i decreased in the observation group at 30 min,120 min during operation and 60 min after withdrawal,and they were lower than those of the control group.The indexes of the control group increased obviously in the above-mentioned time periods.The coagulation index of the observation group was lower than that of the control group at 30 min during operation and 60 min after withdrawal,and coagulation time was longer than that of the control group.In the control group,the coagulation index between 120 min during operation and 60 min after withdrawal was higher than that before the anesthesia induction,and the coagulation time between60 min during operation and 60 min after withdrawal was shorter than that before the anesthesia induction( all P<0.05.).Conclusion Intravenous anesthesia with propofol can reduce platelet[Ca~(2+)]i,inhibit platelet aggregation and relieve intraoperative hypercoagulation in patients with extensive burns.
Objective To explore the effect of propofol intravenous anesthesia on coagulation function and platelet aggregation in patients with extensive burns. Methods 60 cases of patients with extensive burns in the hospital of our research group were selected and divided into two groups( observation group and control group) according to different anesthesia methods.The observation group were given propofol intravenous anesthesia,while the control group were given ketamine intravenous anesthesia.And then,the changes of platelet[Ca~(2+)]i,platelet aggregation rate,coagulation index and coagulation time were compared between the two groups at different times.Results The platelet aggregation rate and platelet[Ca~(2+)]i decreased in the observation group at 30 min,120 min during operation and 60 min after withdrawal,and they were lower than those of the control group.The indexes of the control group increased obviously in the above-mentioned time periods.The coagulation index of the observation group was lower than that of the control group at 30 min during operation and 60 min after withdrawal,and coagulation time was longer than that of the control group.In the control group,the coagulation index between 120 min during operation and 60 min after withdrawal was higher than that before the anesthesia induction,and the coagulation time between60 min during operation and 60 min after withdrawal was shorter than that before the anesthesia induction( all P<0.05.).Conclusion Intravenous anesthesia with propofol can reduce platelet[Ca~(2+)]i,inhibit platelet aggregation and relieve intraoperative hypercoagulation in patients with extensive burns.
引文
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[10]张立贤,曹阳,彭亮,等.不同机械通气方式对大面积烧伤患者每搏量变异度的影响[J].广东医学,2015,36(18):2874-2877.
[11]徐文,谭小云.右美托咪定复合氟比洛芬酯对烧伤患者全身麻醉苏醒期躁动及血液动力学的影响[J].中国现代医学杂志,2015,25(30):86-88.
[2]夏建国,项尽一,王晖,等.异丙酚对严重烫伤兔的肝保护效应[J].中华麻醉学杂志,2015,35(7):834-836.
[3]芮鹏,张建忠.大面积烧伤患者术中发生ARDS成功救治1例报告[J].山东医药,2015,55(40):107.
[4]项尽一,夏建国,张昆,等.不同麻醉药物对兔严重烫伤早期炎性反应的影响[J].重庆医学,2016,45(24):3330-3333.
[5]曹剑,崔剑,顾健腾,等.右美托咪定复合芬太尼用于烧伤换药的镇痛效果观察[J].重庆医学,2015,44(24):3410-3411.
[6]戴寒英,郭余大,吴红,等.喉罩麻醉在婴幼儿烧伤科手术中的应用[J].广东医学,2017,38(2):241-242,246.
[7]王金鑫,史淑珍,李菊红,等.右美托咪定复合七氟烷麻醉在小儿烧伤短小手术中的应用效果观察[J].解放军医学杂志,2016,41(3):254-257.
[8]秦超,边映雪,冯甜甜,等.氢气对重度烧伤小鼠早期肺损伤的影响[J].中华烧伤杂志,2017,33(11):682-687.
[9]李尚坤,闵苏,吴彬,等.地佐辛复合舒芬太尼在烧伤患者术后静脉自控镇痛中的应用[J].中华烧伤杂志,2015,31(1):48-51.
[10]张立贤,曹阳,彭亮,等.不同机械通气方式对大面积烧伤患者每搏量变异度的影响[J].广东医学,2015,36(18):2874-2877.
[11]徐文,谭小云.右美托咪定复合氟比洛芬酯对烧伤患者全身麻醉苏醒期躁动及血液动力学的影响[J].中国现代医学杂志,2015,25(30):86-88.