全麻与椎管内麻醉对老年髋关节置换术患者凝血功能的影响
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摘要
目的研究全麻与椎管内麻醉对老年髋关节置换术患者凝血功能的影响。方法选取我院2016年5月～2017年3月收治的38例行髋关节置换术的患者,根据麻醉方式的不同分为全麻组和椎管内麻醉组,每组各19例。对比两组患者手术前后凝血功能有关指标的变化情况。结果在手术之前,两组患者的凝血酶时间、凝血酶原时间、纤维蛋白原以及活化部分凝血活酶时间的测试结果相似,在手术结束后全麻组的凝血酶时间、凝血酶原时间、纤维蛋白原以及活化部分凝血活酶时间的测试结果明显高于手术之前(P <0.05),而且明显高于椎管内麻醉组(P <0.05);椎管内麻醉组的凝血酶时间、凝血酶原时间、纤维蛋白原以及活化部分凝血活酶时间与手术前比较,差异无统计学意义(P> 0.05)。结论对于老年髋关节置换术患者来说,使用椎管内麻醉方式具有更好的效果,可以有效地维持患者的凝血功能的稳定,值得在行髋关节置换术的老年患者中推广采用。
Objective To investigate the effect of general anesthesia and intraspinal anesthesia on coagulation function in elderly patients with hip replacement. Methods The choice of 38 patients undergoing hip replacement in our hospital from May 2016 to March 2017 were selected and divided into general anesthesia group and intraspinal anesthesia group. According to different anesthesia methods, 19 cases in each group. The changes of the related indexes of blood coagulation function before and after the operation were compared between the two groups. Results Prior to surgery, the thrombin time of the two groups was similar to the test results of the thrombin time, the gelinin, the fibrinogen and the activated part of the coagulation activity time.The results of thrombin time, prothrombin time, fibrinogen and activated partial thromboplastin time in general anesthesia group after operation were significantly higher than those before operation(P < 0.05), and significantly higher than those in intraspinal anesthesia group(P < 0.05); thrombin time, prothrombin time and fibrin in intraspinal anesthesia group There was no significant difference between the original and activated partial thromboplastin time before surgery(P > 0.05). Conclusion For the elderly hip replacement patients, the use of vertebral tube in the anesthesia method has better effect, can effectively maintain the patient's coagulation function stability, worthy of the hip housing replacement of the elderly patients to promote the use.
Objective To investigate the effect of general anesthesia and intraspinal anesthesia on coagulation function in elderly patients with hip replacement. Methods The choice of 38 patients undergoing hip replacement in our hospital from May 2016 to March 2017 were selected and divided into general anesthesia group and intraspinal anesthesia group. According to different anesthesia methods, 19 cases in each group. The changes of the related indexes of blood coagulation function before and after the operation were compared between the two groups. Results Prior to surgery, the thrombin time of the two groups was similar to the test results of the thrombin time, the gelinin, the fibrinogen and the activated part of the coagulation activity time.The results of thrombin time, prothrombin time, fibrinogen and activated partial thromboplastin time in general anesthesia group after operation were significantly higher than those before operation(P < 0.05), and significantly higher than those in intraspinal anesthesia group(P < 0.05); thrombin time, prothrombin time and fibrin in intraspinal anesthesia group There was no significant difference between the original and activated partial thromboplastin time before surgery(P > 0.05). Conclusion For the elderly hip replacement patients, the use of vertebral tube in the anesthesia method has better effect, can effectively maintain the patient's coagulation function stability, worthy of the hip housing replacement of the elderly patients to promote the use.
引文
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[13]丁艺,李永录,林雅丽,等.参麦注射液对老年髋关节置换患者围术期心血管功能的影响[J].广西医学,2014,36(3):377-379.
[14]王彬,张高峰,尹曾,王等.连续星状神经节阻滞对老年髋关节置换术患者血浆S-100β、NSE蛋白和术后认知功能的影响[J].中华临床医师杂志(电子版),2013,7(17):7780-7783.
[15]泮月仙,王钱荣,徐恒艺,等.全身麻醉与腰硬联合麻醉对老年髋关节置换术后患者认知功能的影响[J].全科医学临床与教育,2017,15(5):559-561.
[16]叶晓明,叶军青,徐海涛,等.不同麻醉方法与深度对老年髋关节置换术患者术后早期认知功能的影响[J].临床军医杂志,2013,41(3):250-251,254.
[17]方梅,努尔波拉提·加列力汗,禚海成,等.右美托咪定对老年患者全髋关节置换术后早期认知功能的影响[J].临床麻醉学杂志,2012,28(12):1175-1177.
[2]车志新,廖荣宗,何丽兴,等.喉罩全身麻醉对老年髋关节置换术患者围术期血流动力学及认知功能的影响[J].现代医院,2017,17(4):594-596.
[3]徐怡娜,袁海军,胡益飞.血栓弹力图评价不同麻醉方式对全髋置换术围手术期凝血功能的影响[J].浙江实用医学,2017,22(2):118-119,123.
[4]冯钲华.全身麻醉与硬膜外麻醉对老年髋关节置换术后患者认知功能的影响[J].临床医学,2017,37(4):83-85.
[5]李建辉,郝丽娜,侯少科,等.不同麻醉方式对老年患者髋关节置换术后短期认知功能的影响[J].中国老年学杂志,2017,37(6):1459-1461.
[6]王勇,张元文.椎管内麻醉对髋关节置换术老年患者下呼吸道感染及免疫功能的影响[J].河北医学,2017,23(11):1852-1854.
[7]利鸿胜,银含素,莫朴.不同麻醉方式对老年全髋关节置换术患者术后短期认知功能的影响[J].中国当代医药,2016,23(11):113-115.
[8]谢丹.依托咪酯静脉全麻联合FICB对老年全髋关节置换术POCD的影响[D].泸州,西南医科大学,2016:36-40.
[9]李晓磊,杨晓东,段莹莹.七氟醚复合麻醉对老年髋关节置换患者术后短期认知功能的影响[J].检验医学与临床,2016,13(4):510-512.
[10]杨燕,王中胜.全身麻醉与硬膜外麻醉对老年全髋关节置换术患者术后认知功能的影响研究[J].临床医药实践,2015,24(5):338-340.
[11]张苗芳.不同麻醉方法对老年全髋关节置换术患者术后深静脉血栓发生率的影响对比[A].中华高血压杂志社.中国转化医学和整合医学研讨会论文综合刊[C].中华高血压杂志社,2015:2.
[12]秦娜,魏立伟.血必净注射液对老年全髋关节置换术患者围手术期凝血功能及炎性反应的影响[J].中国中西医结合杂志,2014,34(10):1202-1206.
[13]丁艺,李永录,林雅丽,等.参麦注射液对老年髋关节置换患者围术期心血管功能的影响[J].广西医学,2014,36(3):377-379.
[14]王彬,张高峰,尹曾,王等.连续星状神经节阻滞对老年髋关节置换术患者血浆S-100β、NSE蛋白和术后认知功能的影响[J].中华临床医师杂志(电子版),2013,7(17):7780-7783.
[15]泮月仙,王钱荣,徐恒艺,等.全身麻醉与腰硬联合麻醉对老年髋关节置换术后患者认知功能的影响[J].全科医学临床与教育,2017,15(5):559-561.
[16]叶晓明,叶军青,徐海涛,等.不同麻醉方法与深度对老年髋关节置换术患者术后早期认知功能的影响[J].临床军医杂志,2013,41(3):250-251,254.
[17]方梅,努尔波拉提·加列力汗,禚海成,等.右美托咪定对老年患者全髋关节置换术后早期认知功能的影响[J].临床麻醉学杂志,2012,28(12):1175-1177.