不同麻醉方法对单侧下肢骨关节手术围手术期凝血功能的影响

王琳; 罗宇; 钱家树; 李高炜; 刘江涛; 林学正

doi:10.16766/j.cnki.issn.1674-4152.2017.12.018

不同麻醉方法对单侧下肢骨关节手术围手术期凝血功能的影响

doi: 10.16766/j.cnki.issn.1674-4152.2017.12.018

1. 台州市中心医院麻醉科,浙江台州 318000;
2. 宁波市第二医院骨科,浙江宁波 315312

基金项目:

2014年浙江省医药卫生一般研究计划项目 (2014-KYB234)

详细信息

通讯作者:
林学正,E-mail:LinXZ@TZZXYY.com

中图分类号: R614.2;R687.4
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出版历程
- 收稿日期: 2017-05-31
- 网络出版日期: 2022-08-06

Effects of different anesthesia methods on perioperative coagulation in unilateral lower extremity bone and joint surgery

Department of Anesthesiology, Taizhou Central Hospital of Zhejiang Province, Taizhou, Zhejiang 318000, China

摘要

摘要: 目的探讨全麻、腰硬联合麻醉及硬膜外麻醉对单侧下肢骨关节手术围手术期凝血功能的影响。方法选择台州市中心医院2012年1月—2016年12月单侧下肢骨关节手术患者180例，根据随机数字法分为全麻组、腰硬联合麻醉组和硬膜外麻醉组，每组60例。术后6 h、24 h、48 h对患者进行VAS评分；麻醉前、麻醉后6 h、术后24 h测定凝血功能，记录围手术期血栓性并发症的发生情况。结果腰硬联合麻醉组和硬膜外麻醉组术后6 h、术后24 h和术后48 h VAS评分低于全麻组(P<0.05)，腰硬联合麻醉组术后6 h、术后24 h和术后48 h VAS评分低于硬膜外麻醉组(P<0.05)。全麻组、腰硬联合麻醉组、硬膜外麻醉组麻醉后6 h和术后24 h PT值和TT值均高于麻醉前(P<0.05)，麻醉后6 h APTT值均高于麻醉前(P<0.05)，术后24 h APTT值和麻醉前比较差异无统计学意义(P>0.05)，麻醉后6 h和术后24 h Fbg值均低于麻醉前(P<0.05)。腰硬联合麻醉组和硬膜外麻醉组围手术期血栓性并发症的发生率低于全麻组(P<0.05)。结论腰硬联合麻醉和硬膜外麻醉对单侧下肢骨关节手术的镇痛效果好，能够改善围手术期血液高凝状态，降低围手术期血栓性并发症的发生率，其中腰硬联合麻醉效果更佳。
- 全麻 /
- 腰硬联合麻醉 /
- 硬膜外麻醉 /
- 下肢骨关节手术 /
- 凝血功能
Abstract: Objective To explore the effects of general anesthesia,combined spinal-epidural anesthesia and epidural anesthesia on perioperative coagulation in unilateral lower extremity bone and joint surgery. Methods One hundred and eighty cases of unilateral lower extremity bone and joint surgery patients in the Taizhou Central Hospital from January,2012 to December,2016 were selected,and were divided into general anesthesia group,lumbar combined anesthesia group and epidural anesthesia group according to the random number method,each group was 60 cases.The VAS scores were performed at 6,24 and 48 h after operation.The coagulation function before anesthesia,6 h after anesthesia,24 h after operation were determined.The incidence of thrombotic complications during perioperative period was recorded. Results The VAS score at 6,24 and 48 h after operation of the combined spinal anesthesia group and the epidural anesthesia group were lower than that of the general anesthesia group(P<0.05) The VAS score at 6,24 and 48 h after operation of the combined spinal anesthesia group were lower than that in the epidural anesthesia group(P<0.05).The values of PT and TT in general anesthesia group,lumbar combined anesthesia group and epidural anesthesia group at 6 h after anesthesia,24 h after operation were significantly higher than those before anesthesia(P<0.05),the values of APTT at 6h after anesthesia were significantly higher than those before anesthesia(P<0.05),at 6 h after anesthesia,24 h after operation were significantly lower than those before anesthesia(P<0.05).The incidence of thrombotic complications in the combined spinal epidural anesthesia group and epidural anesthesia group were lower than that in the general anesthesia group(P<0.05). Conclusion The analgesic effect combined spinal epidural anesthesia and epidural anesthesia for unilateral lower extremity bone and joint surgery is good,and combined spinal epidural anesthesia and epidural anesthesia can improve the perioperative hypercoagulable state of blood,reduce the incidence of perioperative thrombotic complications,the effect of combined spinal epidural anesthesia is better.
- General anesthesia /
- Combined spinal epidural anesthesia /
- Epidural anesthesia /
- Lower extremity bone and joint surgery /
- Coagulation function