硬膜外麻醉复合小剂量静脉麻醉对类风湿关节炎伴关节畸形行TKA患者DVT形成的影响

发布时间：2018-03-05 07:07

  本文选题：硬膜外麻醉　切入点：静脉麻醉　出处：《中国骨与关节损伤杂志》2016年08期 　论文类型：期刊论文

【摘要】：目的探讨硬膜外麻醉复合小剂量静脉麻醉对类风湿关节炎伴关节畸形行全膝关节置换术(TKA)患者术后下肢深静脉血栓(DVT)形成的影响。方法自2010-01—2015-08共诊治因类风湿性关节炎伴关节畸形而行TKA的患者60例,按随机数字法平均分为3组,术中分别采用连续硬膜外麻醉(A组)、静-吸复合全身麻醉(B组)和硬膜外麻醉复合小剂量静脉麻醉(C组),观察3组DVT的发生率、术中血流动力学和应激功能指标。结果 B组血浆纤维蛋白原和D-二聚体水平高于其他2组,而抗X因子活性峰值低于其他2组,差异有统计学意义(P0.05)。T0时间点3组血压,心率和BIS值水平均无明显差异,而T1和T2时间点B组血压、心率、BIS值均显著低于其他2组(P0.05);B组DVT发生率高于其他2组,差异有统计学意义(χ~2=13.2,P=0.01)。结论硬膜外麻醉复合小剂量静脉麻醉可稳定术中血流动力学,麻醉效果佳,降低下肢深静脉血栓发生率,其机制与抑制凝血过程有关。
[Abstract]:Objective to investigate the effect of epidural anesthesia combined with low dose intravenous anesthesia on the formation of DVT in patients with rheumatoid arthritis with joint deformity after total knee arthroplasty. Methods the diagnosis and treatment of rheumatoid rheumatoid syndrome were performed from 2010-01-2015-08. TKA was performed in 60 patients with ganglitis associated with joint deformities. According to the random number method, the patients were divided into three groups: group A (continuous epidural anesthesia), group B (combined with general anesthesia) and group C (combined with epidural anesthesia and small dose intravenous anesthesia). The incidence of DVT in the three groups was observed. Results the plasma fibrinogen and D-dimer levels in group B were higher than those in the other two groups, but the peak value of anti-X factor activity was lower than that in the other two groups. There was no significant difference in heart rate and BIS, but the incidence of DVT in group B was significantly lower than that in group B at T 1 and T 2, which was significantly lower than that in group B (P 0.05) and the incidence of DVT in group B was higher than that in group B at T 1 and T 2, respectively. Conclusion epidural anesthesia combined with small dose intravenous anesthesia can stabilize hemodynamics during operation and reduce the incidence of deep venous thrombosis in lower extremity. The mechanism is related to the inhibition of coagulation.
【作者单位】： 当阳长坂坡医院麻醉科;
【分类号】：R614

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