摘要
目的比较全凭静脉麻醉和持续硬膜外阻滞复合静脉麻醉对老年腹部手术围术期血液高凝状态的影响。方法选取2015年11月至2017年10月行腹部手术的老年患者204例,分为全凭静脉麻醉组(TIVA组,100例)和持续硬膜外阻滞复合静脉麻醉组(EIVA组,104例)。监测并记录患者麻醉诱导前(t_0)、手术中(t_1)、手术结束时(t_2)及手术后30 min(t_3)的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_2)、脑电双频指数(BIS);并于手术前、术后12 h及术后3 d检测血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)水平、血清D-二聚体水平、血管性血友病因子(v WF)水平。结果 EIVA组患者的麻醉诱导时间明显长于TIVA组(P<0.05),但麻醉药物用量明显少于TIVA组(P<0.05);在t_1,t_2,t_3时,EIVA组患者的MAP,SpO_2,HR和BIS均明显高于TIVA组(P<0.05),而EIVA组患者术中和术后HR基本稳定,与t_0基础值相比无明显差异(P>0.05);术后12 h和术后3 d,EIVA组患者PLT及FIB水平明显低于TIVA组,血清vWF水平明显高于TIVA组(P<0.05);EIVA组不良反应发生率为9.62%,明显低于TIVA组的25.00%(P<0.05)。结论腹部手术采用硬膜外阻滞复合静脉麻醉,老年患者术中和术后血流动力学较全凭静脉麻醉老年患者更稳定,术后血液高凝状态改善更显著。
Objective To compare the effect of total intravenous anesthesia(TIVA)and continuous epidural block combined with intra venous anesthesia(EIVA)on perioperative blood hypercoagulability in elderly patients undergoing abdominal surgery.Methods Totally 204 elderly patients undergoing abdominal surgery in our hospital from November 2015 to October 2017 were selected and divided into the TIVA group(n=100)and the EIVA group(n=104).The heart rate(HR),mean arterial pressure(MAP),pulse oxygen saturation(SpO2)and bispectral index(BIS)of the patients were monitored and recorded before induction of anesthesia(t0),during surgery(t1),at the end of surgery(t2),and 30 min after surgery(t3).Meanwhile,the platelet count(PLT),prothrombin time(PT),activated partial thromboplastin time(APTT),the levels of fibrinogen(FIB),D-dimer and von Willebrand factor(vWF)before surgery,and 12 h,3 d after surgery were measured and recorded.ResultsThe induction time of anesthesia in the EIVA group was longer than that in the TIVA group(P<0.05),but the dosage of anesthetics in the EIVA group was less than that in the TIVA group(P<0.05).The MAP,SpO2,HR and BIS in the EIVA group at t1,t2,t3were higher than those in the TIVA group(P<0.05),but the HR in the EIVA group was stable during and after surgery,and there was no significant difference compared with the baseline value at t0(P>0.05).12 h and 3 d after surgery,the levels of PLT and FIB in the EIVA group were lower than those in the TIVA group(P<0.05),while the level of serum vWF in the EIVA group was higher than that in the TIVA group(P<0.05).The incidence rate of adverse reactions in the EIVA group was 9.62%,which was significantly lower than 25.00%in the TIVA group(P<0.05).Conclusion In elderly patients undergoing abdominal surgery,the intraoperative and postoperative hemodynamics of patients undergoing EIVA is more stable than that of patients undergoing TIVA,and the improvement of postoperative blood hypercoagulability is more significant.
作者
孙韧
谭和莲
高艳平
刘长军
SUN Ren;TAN Helian;GAO Yanping;LIU Changjun(Zhangjiagang First People′s Hospital,Zhangjiagang,Jiangsu,China 215600;The Second Hospital Affiliated Hospital of Soochow University,Suzhou,Jiangsu,China 215004)
出处
《中国药业》
CAS
2019年第2期78-81,共4页
China Pharmaceuticals
基金
江苏省卫生计生委2015年度青年科研课题[Q201504]
关键词
老年
腹部手术
全凭静脉麻醉
硬膜外阻滞
凝血功能
血流动力学
elderly patients
abdominal surgery
total intravenous anesthesia
epidural block
coagulation function
hemodynamics
