不同麻醉手段對全髖關節置換術后患者凝血、纖溶指標變化和安全性的影響

劉海盛 唐麗雙

【摘要】 目的：研究觀察不同麻醉手段對全髖關節置換術后患者凝血與纖溶指標變化和安全性的影響。方法：選擇2017年6月-2019年10月本院收治的行全髖關節置換術治療患者60例為研究對象，應用計算機數字隨機分配原則將其分為對照組（n=30）與觀察組（n=30），對照組實施全身麻醉干預，觀察組實施腰硬聯合麻醉干預，比較兩組術后凝血、纖溶指標變化及其安全性。結果：觀察組術后呼吸恢復、睜眼、拔管及定向力恢復時間均較對照組縮短，不良反應發生率大幅度降低，差異均有統計學意義（P<0.05）。兩組各項凝血功能指標T0、T1、T3及T4時段相比變化均不明顯，而T2時段則出現增高，且對照組各項凝血指標T2時段變化更明顯，相比T0時段，差異有統計學意義（P<0.05），兩組各時段凝血功能指標對比，差異均無統計學意義（P>0.05）。兩組不同時段PAI-1水平比較，差異均無統計學意義（P>0.05）;兩組T2、T3時段t-PA、D-D比較，差異均有統計學意義（P<0.05），兩組其他時段t-PA、D-D比較，差異均無統計學意義（P>0.05）。結論：全髖關節置換術治療患者術中采用腰硬聯合麻醉方式，可有效避免術后血液高凝狀態，減輕對纖溶功能影響，繼而保證麻醉安全性，值得在臨床中推廣應用。

【關鍵詞】 麻醉手段 全髖關節置換術 凝血 纖溶指標 安全性

[Abstract] Objective： To study the effects of different anesthesia methods on the changes of blood coagulation， fibrinolysis indexes and safety of patients after total hip arthroplasty. Method： 60 patients with total hip arthroplasty in our hospital from June 2017 to October 2019 were selected as the research objects， and they were divided into the control group （n=30） and the observation group （n=30） according to the principle of computer digital random distribution. The control group was given general anesthesia intervention， and the observation group was given combined spinal and epidural anesthesia intervention. The changes of blood coagulation， fibrinolysis indexes and safety of two groups were compared. Result： The time of respiratory recovery， eye opening， extubation and orientation recovery in the observation group were shorter than those in the control group， and the incidence of adverse reactions was significantly reduced， the differences were statistically significant （P<0.05）. There were no significant changes in coagulation function indexes between two groups at T0， T1， T3 and T4， but it increased at T2， the changes of coagulation indexes in the control group were more obvious at T2， compared with T0， the difference was statistically significant （P<0.05）. There were no significant differences in coagulation function between two groups （P>0.05）. There were no significant differences in PAI-1 level between two groups at different time points （P>0.05）. There were significant differences in t-PA and D-D between two groups at T2 and T3 （P<0.05）. There were no significant differences in t-PA and D-D between two groups in time points （P>0.05）. Conclusion： Combined spinal and epidural anesthesia used in patients with total hip arthroplasty can effectively avoid postoperative hypercoagulability， reduce the impact on fibrinolytic function， and ensure the safety of anesthesia， which is worthy of clinical application.

[Key words] Anesthesia method Total hip replacement Blood coagulation Fibrinolytic index Security

First-authors address： Guangzhou City Zengcheng District Peoples Hospital， Guangzhou 511300， China

doi：10.3969/j.issn.1674-4985.2020.21.003

全髖關節置換術廣泛應用于髖關節晚期病變或部分股骨頸骨折的臨床治療中，對于緩解疼痛癥狀、改善患者關節功能有著積極意義，但在術后易并發深靜脈血栓、譫妄、認知功能障礙等并發癥[1]。分析原因得知，術后不同麻醉方式的選擇會對患者肺功能、心腦血管產生較大影響，且部分患者隨著年齡增長，自身機體功能退化，術中循環功能欠穩定，使得麻醉與手術風險增高[2]。因此在手術中選擇合理、安全的麻醉方式對患者預后有著積極意義。目前，臨床中針對行全髖關節置換術治療患者多采用全身麻醉、腰硬聯合麻醉、硬膜外麻醉等方式，不同麻醉手段對患者血流動力學影響存在差異性[3-4]。因而……