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ID:10611153
大小:34.50 KB
页数:10页
时间:2018-07-07
《不同麻醉方式对创伤股骨骨折手术高凝状态影响》由会员上传分享,免费在线阅读,更多相关内容在学术论文-天天文库。
1、不同麻醉方式对创伤股骨骨折手术高凝状态影响【摘要】目的比较丙泊酚靶控输注(TCI)麻醉,腰硬联合椎管内麻醉方法对国人下肢创伤股骨骨折术中、术后TEG、血浆D-Di、PLC、PAgR各参数的影响。方法选择创伤股骨骨折,择期行股骨骨折切开内固定术,年龄20~45岁,ASAⅠ~Ⅱ级的患者60例,随机分3组,各20例。I组采用丙泊酚靶控输注(TCI)静脉麻醉。Ⅱ组为腰麻联合硬膜外麻醉。III组静脉复合全麻联合腰硬麻醉。三组患者均分别于术前、术中麻醉1h、术后48h静脉采血测定D-D二聚体(D-Di)、血小板计数(PLC)、血小板聚集率(PAgR)、凝血弹性描记图(TEG)的相关指标:R、K、
2、α、MA。并与健康成年人上述指标进行比较。结果①三组股骨创伤骨折后术前、术中、术后的D-Di、α角、MA与健康成年人比较增大,R时间、K时间缩短P<0.05。三组病例术中1h和术后48h与术前比较D-Di、PLC、PAgR、α角度、MA均增大,R时间、K时间缩短P<0.05。术中1hI组D-Di、PAgR、a角增加数值与II、III组增加的数值比较P<0.05。术后48hD-Di、TEG的各项指标组间比较差异均无统计学意义。结论10创伤股骨骨折后术前、术中、术后的凝血功能与正常成年人比较血液处于高凝状态且术中、术后比术前更为高凝。手术创伤可能是引起高凝状态的主要因素,麻醉方法是次要因
3、素。但术中麻醉方式、麻醉用药具有其价值,椎管内阻滞麻醉可能有利于改善术中的高凝状态。【关键词】麻醉;股骨骨折;高凝状态DifferentwaysofanesthesiatraumaticfemurfracturesurgeryhypercoagulabilityimpactYANJiang,OUJing-yan,LUOFU-rong,etal.ChineseMedicineHospitalinFoshan,Guangdong528222,China【Abstract】ObjectiveTocomparepropofoltarget-controlledinfusion(TCI)ane
4、sthesia,lumbarspinalanesthesiahardjointapproachtothepeopleoflowerextremityfracturesofthefemurtraumasurgery,postoperativeTEG,plasmaD-Di,PLC,PAgRtheparameters.MethodsTraumaticfractureofthefemur,selectivecutfemurfracturefixation,theageof20-to45-year-old,ASAⅠlevel-~Ⅱlevelof60patientswererandomlydiv
5、idedinto3groups,eachof20cases.GroupIusedpropofoltarget-controlledinfusion(TCI)intravenousanesthesia.Ⅱgroupforspinalepiduralanesthesia.GroupIIIcompoundintravenousanesthesiacombinedspinalanesthesiahard.Threepatientswereinoperationbefore,duringanesthesia101hourh,after48hourshvenousbloodmeasuredDDd
6、imer(D-Di),plateletcount(PLC),therateofplateletaggregation(PAgR),coagulationflexiblepolygraphFigure(TEG)oftherelevantindicators:R,K,α,MA.Andhealthyadultsandcomparedtheseindicators.Results①threefemurfracturesafterthetraumabefore,duringandaftertheD-Di,αangle,MAincreasecomparedwithhealthyadults,Rt
7、ime,KtimeP<0.05.Threecasesofpatientsin1hourandhafter48hourshcomparedwiththepreoperativeD-Di,PLC,PAgR,αpointofview,MAhaveincreased,Rtime,KtimeP<0.05.1hoursurgeryhIGroupD-Di,PAgR,anumericalincreaseintheangleandII,IIIoftheincreaseinv
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