摘要
目的:通过血栓弹力图(TEG)观察术后硬膜外和静脉自控镇痛对食管癌根治术后患者凝血功能的影响。方法:择期行食管癌根治术患者60例,随机双盲分为术后静脉自控镇痛(PCIA)组和术后硬膜外自控镇痛(PCEA)组,每组30例。观察术后6、12、24、48 h视觉模拟评分(VAS)并记录PCA的总按压次数。分别于麻醉前(T0)、术毕(T1)、术后1d(T2)、术后2d(T3)、术后3d(T4)测血小板计数(PLT),并行TEG分析包括测定反应时间(R)、血凝块形成时间(K)、血凝块聚合形成速率(α角)、最大振幅(MA)。结果:1)PCEA组患者在术后各时点的VAS评分均低于PCIA组,PCA总按压次数低于PCIA组(P<0.05)。2)PCEA组不同时点R值和K值的变化与T0比较差异无统计学意义(P>0.05),而在T2、T3、T4时点R值和K值分别较同一时点PCIA组显著延长(P<0.05)。PCEA组在T2、T3、T4时点α角和MA值分别与T0时点相比明显减小,并较同一时点PCIA组显著减小(P<0.05)。3)两组PLT在T2和T3时点均较T0时点显著降低。结论:食管癌根治术后行硬膜外自控镇痛效果优于静脉自控镇痛,并可一定程度改善患者高凝状态。
Objective： To investigate the effect of different analgesia methods on blood coagulation in patients who underwent esophageal carcinoma surgery through thrombelastography （TEG）. Methods：A total of 60 patients who underwent radical esophagectomy were randomly divided into the patient-controlled epidural analgesia （PCEA） group and patient-controlled intravenous analgesia （PCIA） group with 30 cases each. The visual analogue scale （VAS） and patient-controlled analgesia （PCA） bottom pressing times were recorded at 6, 12, 24, and 48 h after surgery. The TEG parameters were measured at the time before anesthesia （T0）, the end of surgery （T1）, first day after operation （T2）, second day after operation （T3）, and third day after operation （T4）. Results：（1） Compared with the PCIA group, the VAS scores and PCA bottom pressing times were significantly lower （P〈0.05）. （2） The R and K values of the PCEA group had no significant difference compared with T0 （P〉0.05）, and were significantly prolonged than those in the PCIA group at T2, T3, and T4 （P〈0.05）. （3） The platelet amount of the two groups decreased at T2 and T3 compared with that at T0 （P〈0.05）. Conclusion：The analgesic effect of PCEA was better than that of PCIA in patients who underwent esophageal carcinoma surgery, and may improve their hypercoagulability.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2015年第7期378-381,共4页
Chinese Journal of Clinical Oncology
基金
卫生部国家临床重点专科建设项目[编号:财社(2011)170)]
重庆市医学重点学科建设项目[(编号:渝卫科教(2007)2号]资助~~
关键词
硬膜外自控镇痛
静脉自控镇痛
食管肿瘤
血栓弹力图
凝血
patient-controlled epidural analgesia, patient-controlled intravenous analgesia, esophageal neoplasm, thrombelastography, coagulation
