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不同麻醉方法对老年患者围手术期血栓前状态的影响
The Effect of Different Anesthetic Methods on Perioperative Pre-thrombosis Status of Senile Patients
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DOI:
作者:
王建珍,王安硈,张姗,陈富强
WANG Jianzhen ,WANG Anqia ,ZHAN Shan ,CHEN Fuqiang
作者单位:
上海市第二人民医院麻醉科
Department of Anesthesiology,Shanghai the Second People,s Hospital,Shanghai
关键词:
老年骨科患者 不同麻醉方法 vWF FIB TAT D-Dimer
geriatric orthopaedic patients, vWF,FIB,TAT,D-Dimer,different anesthetic methods,
摘要:
目的 比较不同麻醉方法对老年骨科患者vWF、FIB、TAT和D-Dimer的影响。方法 择期行髋部以下骨科手术的老年患者60例,年龄>65岁,ASAⅠ-Ⅱ级。采用随机数字表法将患者随机分为3组(n=20):硬膜外麻醉组(A组)、硬膜外加全麻组(B组)和全麻组(C组)。A和B组于L2-3行硬膜外穿刺置管,给予2%利多卡因5ml试验量,观察5min无全脊麻症状,A组继注0.375%罗哌卡因5~15ml,B组于诱导插管后再注0.375%罗哌卡因5~15ml,A和B组术中每隔60min硬膜外追加罗哌卡因4-5ml,A组于消毒皮肤时静注2mg咪唑安定。B和C组麻醉诱导:依次给予咪唑安定0.03mg/kg、舒芬太尼0.3μg/kg、丙泊酚2mg/kg、罗库溴铵0.9mg/kg,待下颌松弛行气管插管,IPPV,Vt8-10ml/kg,f10-12次/min,维持PetCO230~40mmHg。术中持续静脉注射丙泊酚2-4mg.kg-1.h-1和瑞芬太尼0.1-0.2μg.kg-1.min-1,按需给予罗库溴铵10-25mg/次和吸入体积分数为0.6-2.0%七氟烷。3组分别在T1、T2、T3、T4和T5,5个时点采血测定vWF、FIB、TAT和D-Dimer。结果 1)vWF:与T1时比较,T2,3时A组,T3时B组;与C组比较,T2,3时A、B2组vWF显著下降(P<0.05,P<0.01)。2)FIB:与T1时比较,T2,3时A、B2组FIB显著下降(P<0.01),T4,5时3组FIB显著上升(P<0.05,P<0.01);与C组比较,T2-4时A组、T3,4时B组FIB显著下降(P<0.05,P<0.01)。3)TAT:与T1时比较,T4,5时3组TAT显著上升(P<0.05);与C组比较,T3时A、B2组TAT显著下降(P<0.05,P<0.01)。4)D-Dimer:除T3时C组D-Dimer显著高于T1时(P<0.05),其余各时间点组内组间比较差异无统计学意义(P>0.05)。结论 硬膜外麻醉和硬膜外加全麻能改善髋部以下骨科手术老年患者术中的高凝血状态,有助于预防围手术期心脑血管病和下肢深静脉血栓的发生,是老年患者手术适宜选择的麻醉方法。
Objective: To study the influence of different anesthetic methods on vWF、FIB、TAT and D-Dimer of geriatric orthopaedic patients Methods: 60 senile patients (>65 yrs, ASAⅠ-Ⅱ) scheduled for orthopedic surgery below hip joint were randomly assigned to three groups (n=20): epidural anesthesia group (A group), general anesthesia combined with epidural block group (B group) and general anesthesia group (C group).Epidural catheter was inserted between L2 and L3 in group A and B. Group A patients received 5 ml 2% lidocaine for test at first, and then 5-15 ml 0.375% ropivacaine. Group B patients received 5-15 ml 0.375% ropivacaine after tracheal intubation. Ropivacaine 4-5 ml was injected to epidural cavity every 60 min in group A and B. Group A patients received 2 mg midazolam during disinfection of skin. Patients in group B and C were induced by midazolam 0.03 mg/kg, sufentanil 0.3μg/kg, propofol 2 mg/kg and rocuronium 0.9 mg/kg and then IPPV was conducted. Propofol 2-4mg•kg-1•h-1 and remifentanil 0.1-0.2μg•kg-1•min-1 were given during the operation and rocuronium 10-25 mg and 0.6-2.0% sevoflurane were given quoties in group B and C. Several data including vWF, FIB, TAT and D-Dime were collected at T1、T2、T3、T4and T5 .Results: The data of vWF at T2, T3 in group A and T3 in group B were decreased significantly compared with T1 (P<0.05,P<0.01). The data of vWF at T2, T3 in group A and B were decreased significantly compared with group C (P<0.05,P<0.01). Compared with T1, the data of FIB at T2, T3 in group A and B were decreased significantly (P<0.01), while T4, T5 in all three groups were increased significantly (P<0.05,P<0.01). The data of FIB at T2-4 in group A and T3, T4 in group B were decreased significantly compared with group C (P<0.05,P<0.01). The data of TAT at T4, T5 in all three groups were increased significantly compared with T1 (P<0.05). The data of TAT at T3 in group A and B were decreased significantly compared with group C (P<0.05,P<0.01). The data of D-Dimer at T2, T4, T5 in group C were increased significantly compared with T1 (P<0.05). There were no differences of D-Dimer among the three groups and within group A and B (P>0.05). Conclusions: Epidural anesthesia and general anesthesia combined with epidural block are suitable for senile patients undergoing orthopedic surgery below hip joint, because they both can improve hypercoagulabale state of senile patients during the surgery, and may prevent perioperative cardiovascular and cerebrovascular diseases and deep venous thrombosis of lower extremity.
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