高龄关节置换术中不同麻醉方式对患者凝血功能的影响
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摘要
目的探讨高龄关节置换术中应用全麻和硬膜外麻醉对患者凝血功能产生的影响。方法 2017年9月—2018年6月在单县中心医院方便选取128例行关节置换术高龄患者进行研究,随机分为对照组(63例)和观察组(65例),分别实施全身麻醉和硬膜外麻醉。观察不同时间点两组各项凝血指标以及D-二聚体水平,比较两组的术后深静脉血栓发生率。结果不同时间点两组各项凝血功能指标均未出现明显的波动,且两组不同时间点指标水平比较差异无统计学意义(P>0.05);但观察组麻醉后6 hD-二聚体水平(1.31±0.32)μg/mL与术后第1天清晨D-二聚体水平(1.03±0.7)μg/mL均显著低于对照组(1.62±1.43)μg/mL、(1.45±0.77)μg/mL,均差异有统计学意义(P<0.05),术后随访12个月,经复查观察组深静脉血栓发生率(6.15%)显著低于对照组(23.81%),差异有统计学意义(χ~2=6.554,P<0.05)。结论高龄关节置换术中,应用全麻和硬膜外麻醉均可以获得理想的效果,不会对患者的凝血功能产生明显的影响,但实施硬膜外麻醉可以更好的减少术后深静脉血栓的发生,具有一定的临床应用优势。
Objective To investigate the effect of general anesthesia and epidural anesthesia on blood coagulation function in elderly patients with joint replacement. Methods The Shanxian Central Hospital has brought 128 elderly patients undergoing arthroplasty into studying from September 2017 to June 2018. And they were convenient divided into control group that planned to implement general anesthesia with 63 cases and observation group that planned to implement epidural anesthesia with 65 cases. Next, coagulation indexes and D-dimer levels at different time points of the two groups were separately observed, and postoperative rate of deep vein thrombosis was compared. Results There was no obvious fluctuation in the coagulation function index of the two groups at different points of time, and there was no significant difference in the level of the two groups at different points of time,(P>0.05). But D-dimer levels after 6 h anesthesia and postoperative day1 morning in the observation group were(1.31±0.32)μg/mL,(1.03±0.7)μg/mL, which were significantly lower than those in the control group(1.62±1.43)μg/mL,(1.45±0.77)μg/mL. The difference was statistically significant(P<0.05). Patients were followed up for 12 months. The incidence of deep vein thrombosis in the observation group was 6.15%, which was significantly lower than that of the control group(23.81%). The difference was statistically significant(χ2=6.554, P<0.05). Conclusion In advanced joint replacement surgery, both general anesthesia and epidural anesthesia can achieve ideal results without significantly affecting the patient's coagulation function. Epidural anesthesia can better reduce the occurrence of postoperative deep vein thrombosis and has certain clinical application advantages.
Objective To investigate the effect of general anesthesia and epidural anesthesia on blood coagulation function in elderly patients with joint replacement. Methods The Shanxian Central Hospital has brought 128 elderly patients undergoing arthroplasty into studying from September 2017 to June 2018. And they were convenient divided into control group that planned to implement general anesthesia with 63 cases and observation group that planned to implement epidural anesthesia with 65 cases. Next, coagulation indexes and D-dimer levels at different time points of the two groups were separately observed, and postoperative rate of deep vein thrombosis was compared. Results There was no obvious fluctuation in the coagulation function index of the two groups at different points of time, and there was no significant difference in the level of the two groups at different points of time,(P>0.05). But D-dimer levels after 6 h anesthesia and postoperative day1 morning in the observation group were(1.31±0.32)μg/mL,(1.03±0.7)μg/mL, which were significantly lower than those in the control group(1.62±1.43)μg/mL,(1.45±0.77)μg/mL. The difference was statistically significant(P<0.05). Patients were followed up for 12 months. The incidence of deep vein thrombosis in the observation group was 6.15%, which was significantly lower than that of the control group(23.81%). The difference was statistically significant(χ2=6.554, P<0.05). Conclusion In advanced joint replacement surgery, both general anesthesia and epidural anesthesia can achieve ideal results without significantly affecting the patient's coagulation function. Epidural anesthesia can better reduce the occurrence of postoperative deep vein thrombosis and has certain clinical application advantages.
引文
[1]孙辉,臧学慧,高立华,等.血栓弹力图在评价膝关节置换患者术后下肢深静脉血栓形成的临床价值研究[J].中华关节外科杂志:电子版,2015,9(2):170-173.
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[5]吴迪,刘岩,祁宝昌,等.下肢骨折患者围术期行D-二聚体检测及彩色多普勒血流显像筛查的价值及意义[J].中国老年学杂志,2016,36(11):2706-2708.
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[9]艾克热木江·木合热木,黄筑忆,冯磊,等.不同麻醉方式对膝关节置换后下肢静脉血栓形成的影响:Meta分析[J].中国组织工程研究,2015,19(35):5735-5740.
[10]魏晓,田国刚.术后认知功能障碍影响因素的研究进展[J].中华临床医师杂志:电子版, 2016(6):163-164.
[11]马华山,刘金山,田玲,等.高龄全膝关节置换中全麻和硬膜外麻醉对凝血功能的影响[J].中国组织工程研究,2015,19(35):5610-5614.
[12]陆志伟.三种全身麻醉方法对老年病人术后认知功能的影响[J].中国老年学杂志,2012, 32(24):5592.
[2]魏凤香.临床分析高龄关节置换术中全麻和硬膜外麻醉的麻醉效果[J].航空航天医学杂志,2016,27(1):64-66.
[3]程礼.硬膜外麻醉与全麻在高龄患者行髋关节置换术中的应用效果分析[J].中国冶金工业医学杂志,2015,32(6):668-669.
[4]皮勇,杨义辉,周明强,等.硬膜外麻醉在80岁以上老年患者髋关节置换术中的应用体会[J].中国社区医师,2015,10(36):65-66.
[5]吴迪,刘岩,祁宝昌,等.下肢骨折患者围术期行D-二聚体检测及彩色多普勒血流显像筛查的价值及意义[J].中国老年学杂志,2016,36(11):2706-2708.
[6] Hollmann M W,Kathrin S,Wieczorek MS,et al.Epidural anes-thesia prevents hypercoagulation in patients undergoing major or-thopedic surgery[J].Regional Anesthesia and Pain Medicine,2001,3(26):215-222.
[7] Bruckner S,Reinke U,Roth-Isigkeit A,et al.Comparison of general and spinal anesthesia and their influence on hemostatic markers in patients undergoing total hip arthroplasty[J].Jouranof Clinical Anesthesia,2015,9(15):433-440.
[8]程斌.不同麻醉方法对老年下肢骨折患者手术时v WF、FIB、TAT及D-二聚体的影响[J].现代中西医结合杂志,2016,25(11):1223-1225.
[9]艾克热木江·木合热木,黄筑忆,冯磊,等.不同麻醉方式对膝关节置换后下肢静脉血栓形成的影响:Meta分析[J].中国组织工程研究,2015,19(35):5735-5740.
[10]魏晓,田国刚.术后认知功能障碍影响因素的研究进展[J].中华临床医师杂志:电子版, 2016(6):163-164.
[11]马华山,刘金山,田玲,等.高龄全膝关节置换中全麻和硬膜外麻醉对凝血功能的影响[J].中国组织工程研究,2015,19(35):5610-5614.
[12]陆志伟.三种全身麻醉方法对老年病人术后认知功能的影响[J].中国老年学杂志,2012, 32(24):5592.