不同镇痛方式对食管癌根治术后患者凝血功能的影响

发布时间：2018-02-27 04:11

本文关键词： 硬膜外自控镇痛静脉自控镇痛食管肿瘤血栓弹力图凝血doi ./j.issn.-.　出处：《中国肿瘤临床》2015年07期 　论文类型：期刊论文

【摘要】：目的:通过血栓弹力图(TEG)观察术后硬膜外和静脉自控镇痛对食管癌根治术后患者凝血功能的影响。方法:择期行食管癌根治术患者60例,随机双盲分为术后静脉自控镇痛(PCIA)组和术后硬膜外自控镇痛(PCEA)组,每组30例。观察术后6、12、24、48 h视觉模拟评分(VAS)并记录PCA的总按压次数。分别于麻醉前(T0)、术毕(T1)、术后1d(T2)、术后2d(T3)、术后3d(T4)测血小板计数(PLT),并行TEG分析包括测定反应时间(R)、血凝块形成时间(K)、血凝块聚合形成速率(α角)、最大振幅(MA)。结果:1)PCEA组患者在术后各时点的VAS评分均低于PCIA组,PCA总按压次数低于PCIA组(P0.05)。2)PCEA组不同时点R值和K值的变化与T0比较差异无统计学意义(P0.05),而在T2、T3、T4时点R值和K值分别较同一时点PCIA组显著延长(P0.05)。PCEA组在T2、T3、T4时点α角和MA值分别与T0时点相比明显减小,并较同一时点PCIA组显著减小(P0.05)。3)两组PLT在T2和T3时点均较T0时点显著降低。结论:食管癌根治术后行硬膜外自控镇痛效果优于静脉自控镇痛,并可一定程度改善患者高凝状态。
[Abstract]:Objective: to observe the effect of postoperative patient-controlled epidural analgesia (PCEA) and intravenous analgesia (PCEA) on coagulation function of patients with esophageal cancer after radical resection by thromboelastography (TEG). The patients were randomly divided into two groups: PCIA group and PCEA group. In each group of 30 patients, the visual analogue score (VAS) and the total compression times of PCA were observed and recorded before anesthesia. The platelet count was measured at 1 day after anesthesia, 1 day after operation, 2 days after operation, 3 days after operation, and 3 days after operation. The time of clot formation and the rate of aggregation of blood clots (伪 -angulation, maximum amplitude) were measured. Results the VAS scores of the patients in the group of 1: 1 PCEA were lower than those in the group of PCIA at different time points, and the changes of R value and K value at different time points were lower than those in the group of PCIA. There was no significant difference in T0, but the values of R and K in T2T3T4 group were significantly longer than those in PCIA group at the same time point. The 伪 angle and MA value at T2T3T4 time point and MA value were significantly decreased compared with T0 time point, respectively. Compared with PCIA group at the same time point, the PLT of both groups was significantly lower than that of T0 time point. Conclusion: the effect of epidural analgesia after radical resection of esophageal cancer is better than that of P0.05. 3) the hypercoagulable state of the patients can be improved to some extent.
【作者单位】：重庆医科大学附属第一医院麻醉科;
【基金】：卫生部国家临床重点专科建设项目[编号:财社(2011)170)] 重庆市医学重点学科建设项目[(编号:渝卫科教(2007)2号]资助~~
【分类号】：R614;R735.1

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