CAJ | 학술논문

背景：在行全膝关节置换的高龄患者围手术期，维持正常的凝血功能至关重要。但多种因素会对患者的围手术期凝血功能产生影响，其中麻醉是一重要的因素。不同的麻醉方式会对患者的凝血功能产生不同的影响，临床需要积极的选择适当的麻醉方式以维持稳定的凝血功能。 　　目的：观察全麻和硬膜外麻醉在高龄全膝关节置换中的应用及对患者凝血功能的影响。 　　方法：回顾性分析山东省立集团东营医院2012年9月至2013年9月收治的135例行全膝关节置换高龄患者的临床资料，按照麻醉方式分为两组，对照组67例给予全身麻醉，观察组68例给予硬膜外麻醉。观察两组患者麻醉前、麻醉后6 h、置换后第1天清晨的凝血指标和D-二聚体水平变化，随访12个月检测两组深静脉血栓发生情况，并进行比较。 　　结果与结论：经统计和比较，两组患者在不同时间点的凝血功能各项指标差异均无显著性意义(P均>0.05)；但两组患者的D-二聚体水平在麻醉后6h以及置换后第1天清晨差异有显著性意义，观察组显著低于对照组(P均<0.05)；观察组和对照组的置换后深静脉血栓发生率分别为3%和21%，差异有显著性意义(P<0.05)。表明在高龄全膝关节置换中对患者实施硬膜外麻醉可以获得更好的应用效果，维持稳定的凝血功能状态。
배경：재행전슬관절치환적고령환자위수술기，유지정상적응혈공능지관중요。단다충인소회대환자적위수술기응혈공능산생영향，기중마취시일중요적인소。불동적마취방식회대환자적응혈공능산생불동적영향，림상수요적겁적선택괄당적마취방식이유지은정적응혈공능。 　　목적：관찰전마화경막외마취재고령전슬관절치환중적응용급대환자응혈공능적영향。 　　방법：회고성분석산동성립집단동영의원2012년9월지2013년9월수치적135례행전슬관절치환고령환자적림상자료，안조마취방식분위량조，대조조67례급여전신마취，관찰조68례급여경막외마취。관찰량조환자마취전、마취후6 h、치환후제1천청신적응혈지표화D-이취체수평변화，수방12개월검측량조심정맥혈전발생정황，병진행비교。 　　결과여결론：경통계화비교，량조환자재불동시간점적응혈공능각항지표차이균무현저성의의(P균>0.05)；단량조환자적D-이취체수평재마취후6h이급치환후제1천청신차이유현저성의의，관찰조현저저우대조조(P균<0.05)；관찰조화대조조적치환후심정맥혈전발생솔분별위3%화21%，차이유현저성의의(P<0.05)。표명재고령전슬관절치환중대환자실시경막외마취가이획득경호적응용효과，유지은정적응혈공능상태。
BACKGROUND:In perioperative period of total knee replacement in elderly patients, it is crucial to maintain the normal function of blood coagulation. However, many factors may influence coagulation function of patients in perioperative period. Of them, anesthesia is an important factor. Different anesthesia methods wil produce different effects on blood coagulation. Appropriate anesthesia methods should be selected in the clinic to maintain the stability of coagulation function. OBJECTIVE:To explore the effect of application of general anesthesia and epidural anesthesia in elderly knee replacement and the effects on the function of blood coagulation. METHODS:A retrospective analysis was performed on clinical data of 135 elderly patients after total knee replacement in Dongying Hospital of Shandong Provincial Hospital Group from September 2012 to September 2013. Al patients were divided into control group (67 cases;general anesthesia) and observation group (68 cases;epidural anesthesia) according to the mode of anesthesia. Coagulation indexes and D-dimer levels were observed before anesthesia, 6 hours after anesthesia, and 1 day after replacement in both groups. The incidence of deep venous thrombosis was measured and compared between the two groups in 12-month fol ow-up. RESULTS AND CONCLUSION:Through the statistics and comparison, no significant difference was detected in blood coagulation indexes at different time points in the two groups (al P>0.05). However, significant differences in D-dimer levels were detectable between the two groups at 6 hours after anesthesia and in the morning at 1 day after replacement. D-dimer levels were significantly lower in the observation group than in the control group (al P<0.05). The incidences of deep venous thrombosis were 3%and 21%in the observation and control groups, respectively, showing significant differences (P<0.05). These results suggest that epidural anesthesia during elderly totak knee replacement obtained good effects, and could maintain stable coagulation function.