摘要
目的 观察不同术后镇痛方式对应用低分子肝素（LMWH）的全髋置换术（THR）患者术后血液流变学和凝血功能的影响.方法 择期行THR患者随机分为4组,E0组：术后硬膜外镇痛（PCEA）未用LMWH;EL组：PCEA联合应用LMWH;I0组：术后静脉镇痛（PCIA）未用LMWH;IL组：PCIA联合应用LMWH.于入院检查时（基础值）、术毕、术后24 h、术后48 h及术后7 d抽取静脉血检测血液流变学和凝血功能指标.术后24 h及48 h行视觉模拟评分法（VAS）镇痛评分,术前和术后第7天双下肢血管B超检查,记录并发症的发生情况.结果 四组患者静息和活动时VAS评分无差异.EL和IL两组患者下肢静脉血栓阳性率低于I0和E0组,EL和IL之间及I0和E0之间差异无统计学意义.IL组术后恶心的患者数较E0和EL组增多（P＜0.05）.纤维蛋白原浓度术毕和术后24 h时4组患者均低于基础值（P＜0.05）.血浆黏度和全血黏度E0组低于I0组（P＜0.05）,IL和EL组低于I0和E0组（P＜0.05）,IL和EL之间差异无统计学意义.IL和EL术后各时点凝血酶原时间和激活部分凝血活酶时间均较基础值延长（P＜0.05）,且较I0和E0组延长（P＜0.05）.各组间术中和术后出血量差异无统计学意义.结论 THR患者围术期未用LMWH时PCEA改善血液流变学的作用优于PCIA.PCEA和PCIA联合应用LMWH,均能减少静脉血栓的发生,改善凝血功能和血液流变学指标,且不增加出血,提示应用LMWH时行椎管内麻醉和PCEA是安全可行的.在应用LMWH时,PCEA预防DVT的作用并无明显优势.
Objective To observe the effect of different analgesia combined with low molecular heparin （LMWH） on hameorheology and cogulation in patients undergoing total hip replacement （THR）.Methods Patients undergoing THR with spinal combined epidural anesthesia（SCEA） were randomized to one of four groups： group E0 received patient-controlled epidural analgesia （ PCEA ） without LMWH; group EL sames but combined with LMWH; group I0 received patient-controlled intravenous analgesia （PCIA） without LMWH and IL the sames but combined with LMWH . Venous blood samples were taken after hospitalization, at the end of operation, 24 h, 48 h and 7 d after operation for determination of hameorheology, indexes of coagulation function. Visual analogue scale（VAS） scores were recorded at 24 h and 48 h postoperation. All the patients received colour Doppler ultrasonograhy examination before operation, and on the 7th day after operation. Complication of perioperation were recorded. Results There was no significant change in VAS among the four groups. The rates of DVT occurrence in group IL and EL were significantly lower than in group I0 and E0 （ P ＜ 0.05 ）, and there was no significant difference between group IL and EL or between group I0 and E0. The incidence of nausea was markedly higher in group IL than that in group E0 and EL. Fib of all patients were significantly decreased at the end of operation and 24 h postoperation compared with base line values （ P ＜ 0.05 ）, there was no significant difference each other in the four groups. Plasma viscosity and blood viscosity were lower in group E0 than in group I0 after operation （P ＜ 0.05 ）, and lower in group IL and EL than in group E0 and group I0 after operation （ P ＜ 0.05 ）. There was no significant difference in plasma viscosity and blood viscosity between group IL and EL. There was no significant change in PT and APTT in group I0 and E0 at all times, and no difference between the two groups.PT and APTT in group IL and EL were significan
出处
《中华医学杂志》
CAS
CSCD
北大核心
2010年第17期1171-1176,共6页
National Medical Journal of China
基金
浙江省科技厅面上科研软科学基金（2007C25045）
关键词
低分子肝素
镇痛
硬膜外
静脉
关节成形术
置换
髋
血栓
Low-molecular-weight heparin
Analgesia, epidural, intravenous
Arthroplasty,replacement, hip
Thromboembolism
