采用血栓弹力图评估不同麻醉方式对膝关节置换术患者血液凝固动态变化的影响

发布时间：2018-08-09 09:49

【摘要】：目的采用血栓弹力图来评估不同麻醉方式对膝关节置换术患者围手术期凝血功能的影响,为临床选择更佳的麻醉方式提供依据。方法选取2013年12月-2015年9月中南大学湘雅医院入院治疗的188例单膝关节置换术患者进行研究。随机分为两组,各94例。对照组采用全身麻醉,观察组采用神经阻滞麻醉,分别在手术前、手术中以及手术后取静脉血测定血栓弹力图,指标包括凝固时间(k)、凝血活酶生成时间(r)、血栓最大值(MA)、凝固角(α)、凝血综合指数(CI)和血栓最大值确定后30 min内血凝块幅度减少速率(LY30)。结果与手术前和手术中比较,全身麻醉组r、k明显降低,α、MA、CI和LY30明显升高,差异有统计学意义(P=0.003),而神经阻滞麻醉组仅有LY30有明显升高,差异有统计学意义(P=0.023);在手术后两组参数比较中,神经阻滞麻醉组患者的r明显高于全身麻醉组,α、MA、LY30和CI均明显低于全身麻醉组,差异有统计学意义(P=0.006),与全身麻醉组比较,观察组的k值也有升高的趋势,但差异无统计学意义(P=0.086);手术后对照组发生深静脉血栓(DVT)的比例为10.6%,观察组DVT的比例为0%,差异有统计学意义(P=0.030)。结论手术后患者的凝血功能明显发生变化,其中全身麻醉具有明显促进凝血的效应,相比之前,神经阻滞麻醉可以逆转这种凝血效应,并且患者发生DVT的比例更低,值得临床推广应用。
[Abstract]:Objective to evaluate the effect of different anesthetic methods on coagulation function of knee arthroplasty patients by thromboelastography, and to provide evidence for clinical selection of better anesthesia methods. Methods 188 patients with single knee arthroplasty who were hospitalized in Xiangya Hospital of Central South University from December 2013 to September 2015 were studied. They were randomly divided into two groups, 94 cases in each group. The control group was anesthetized by general anesthesia, the observation group by nerve block anesthesia, and the venous blood was taken before, during and after operation to determine the thromboelastogram. The indexes included coagulation time (k), thromboplastin production time (r), thrombus maximum (MA), coagulation angle (伪) coagulation synthesis index (CI) and thrombus reduction rate (LY30) within 30 min after the determination of coagulation time. Results compared with those before and during the operation, the rnk of general anesthesia group decreased significantly, the 伪 -malacci and LY30 increased significantly (P0. 003), while the LY30 of nerve block anesthesia group was significantly higher than that of general anesthesia group (P < 0. 003), but that of nerve block group was significantly higher than that of general anesthesia group (P < 0. 003). The difference was statistically significant (P0. 023), the r of the patients with nerve block anesthesia was significantly higher than that of the general anesthesia group (P < 0. 023), and the r of the patients with nerve block anesthesia was significantly lower than that of the general anesthesia group (P < 0. 006), and the difference was statistically significant (P < 0. 006), compared with that of the general anesthesia group. The k value of the observation group also increased, but the difference was not statistically significant (P0.086), the proportion of (DVT) in the control group was 10.6, and the proportion of DVT in the observation group was 0, the difference was statistically significant (P0.030). Conclusion the coagulation function of patients after operation is obviously changed, and general anesthesia has obvious effect of promoting coagulation. Compared with before, nerve block anesthesia can reverse the coagulation effect, and the proportion of patients with DVT is lower. It is worth popularizing and applying in clinic.
【作者单位】：中南大学湘雅医院麻醉科;
【分类号】：R614

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