摘要
目的:通过观察不同麻醉方法对择期行腹部手术的老年患者围术期不同时点的血栓前状态指标变化的影响,探讨不同麻醉方法对围术期卒中发生高危因素的影响。方法:采用前瞻性随机对照研究方法,美国麻醉医师协会(American Society ofAnesthesiologists,ASA)分级Ⅰ～Ⅱ级且择期行腹部手术的老年患者24例,术前均无心、肺、脑合并症,将其随机分为3组:全麻联合硬膜外阻滞麻醉组(n=8),全麻组(n=8),硬膜外阻滞组(n=8)。全麻联合硬膜外阻滞麻醉组采用异丙酚全凭静脉麻醉联合硬膜外阻滞,硬膜外阻滞选用0.375%布比卡因;全麻组采用异丙酚全凭静脉麻醉;硬膜外阻滞麻醉组采用单纯硬膜外阻滞麻醉,硬膜外阻滞选用0.5%布比卡因。分别在诱导前(T1)、诱导后(T2)(硬膜外阻滞麻醉组为手术开始即刻)、术毕即刻(T3)、术后72 h(T4)抽取静脉血,检测血管性假血友病因子(von Willebrand factor,vWF)、纤维蛋白原(fibrinogen,FIB)、凝血酶-抗凝血酶复合物(thrombin-antithrombin complexes,TAT)、D-二聚体(D-dimer,DD)水平的变化。结果:(1)vWF:T2时全麻组vWF水平显著高于其他2组;T3时全麻组vWF水平显著高于硬膜外阻滞麻醉组,全麻联合硬膜外阻滞麻醉组和硬膜外阻滞麻醉组间无显著差异。(2)FIB:3组各时间点组间无显著差异。(3)DD:T2时全麻组DD水平显著高于全麻联合硬膜外阻滞麻醉组。(4)TAT:3组各时间点组间无显著差异。结论:对于行腹部手术的老年患者,与单纯全麻相比,全麻联合硬膜外阻滞麻醉和单纯硬膜外阻滞能减少因手术应激引起的血管内皮损伤以及血小板活化、降低围术期老年患者的高凝状态,但不能显著改善患者的纤溶状态,故这两种麻醉方法有利于维持患者的凝血、纤溶、抗凝系统的动态平衡,降低围术期卒中发生的风险。
Objective：To compare the changes of prethrombotic state（PTS） markers in elderly patients undergoing abdominal operations using different anesthesia techniques at differents time points of the perioperative period, and thus to explore the influence of different anesthesia techniques on perioperative stroke in elderly patients. Methods： It was a prospective randomized control study. Twenty-four elderly patients of American Society of Anesthesiologists （ASA）grade I or II undergoing selective abdominal surgeries were divided randomly into three groups. Patients in Group A （n = 8） received general anesthesia combined, with continuous epidural anesthesia;while patients in Group B（n = 8） received general anesthesia, and patients in Group C（n = 8） received continuous epidural anesthesia. In Group B, patients underwent patient-controlled intravenous analgesia （PCIA） ;while in Group A and Group C, patients were given 0. 375% and 0.5% bupivacaine to maintain the block level. Blood samples were taken pre-anesthesia （T,）, at the end of induction （T2） （the same time as when lacerating skins for Group C） at the end of operation （Z3） and postoperative 72 h（T4 ） to determine the levels of yon Willebrand factor（vWF）, fibrinogen （FIB）, thrombin antithrombin complexes （TAT） and D-dimer. Results： （1） The level of vWF in Group B was higher than that in Group A and Group C at T2 ; The level of Group B was higher than Group C at T3 ,while there were no significant differ ences between Group A and Group C. （2） There were no significant difference in the levels of FIB among the 3 groups at all the four time points. （3） The level of DD in Group B at T： was higher than that in Group A. （4） The differences among the three groups at all the four time points were not significant. Conclusions： Compared with general anesthesia, continuous epidural an- esthesia or general anesthesia combined with continuous epidural anesthesia decreases the activity of platelet caus
出处
《中国临床医学》
2012年第5期525-528,共4页
Chinese Journal of Clinical Medicine
关键词
老年
卒中
围手术期
血栓前状态
麻醉方法
Elderly
Stroke
Perioperative period
Prethrombotic state
Anesthesia technique
