【摘要】：目的 :探討全身麻醉和硬膜外麻醉對老年骨科患者凝血功能及術后認知功能的影響。方法 :選取2015年2月至2016年2月擬在我院進行全膝關節(jié)置換術的98例患者,按照麻醉方式的不同分為兩組:A組(硬膜外麻醉組,50例),B組(全身麻醉組,48例)。分別于麻醉前(T1)、麻醉后6h(T2)、術后24h(T3)抽取兩組患者的靜脈血5m L,檢測患者血清中血小板含量、纖維蛋白原濃度(FIB)、凝血原酶時間(PT)、部分激活凝血活酶時間(APTT)、D-二聚體水平,并分別于麻醉前(T1)、麻醉后6h(T2)、術后24h(T3)、麻醉后3d(T4)、麻醉后5d(T5)時間點采用簡易精神狀態(tài)評分量表(MMSE)評估患者的認知功能。結果 :兩組患者一般情況比較差異無統計學意義,具有可比性;兩組患者T1時點PT、APTT、FIB、D-二聚體、血小板含量相比差異無統計學意義,T2~T3時點,兩組患者PT均高于術前水平但組間相比無統計學意義,A組患者APTT明顯高于B組而FIB、D-二聚體、血小板含量明顯低于B組,差異有統計學意義;兩組患者T1、T5時間點MMSE評分相比差異無統計學意義,T2~T4時間點A組MMSE評分顯著高于B組,差異有統計學意義。結論:與全麻相比,對老年骨科患者實施硬膜外麻醉不僅能夠顯著改善凝血功能而且對患者術后認知功能的影響更小,更有助于患者術后的恢復。
[Abstract]:Objective: to investigate the effects of general anesthesia and epidural anesthesia on coagulation function and postoperative cognitive function in elderly orthopedic patients. Methods: from February 2015 to February 2016, 98 patients with total knee arthroplasty were divided into two groups: group A (epidural anesthesia group, n = 50) and group), B (general anesthesia group, n = 48). Before anesthesia (T1), 6 hours after anesthesia (T2) and 24 hours after anesthesia (T3), the venous blood samples of the two groups were taken to detect platelet content, fibrinogen concentration, (FIB), thromboplastin time (PT),. The time of partial activation of thromboplastin (APTT), D-dimer) was measured before anesthesia (T1), at 6h (T2) after anesthesia, at 24h (T3) after anesthesia, and at 3D (T4) after anesthesia. The cognitive function of the patients was assessed by mini mental state scale (MMSE) at 5 days after anesthesia (T 5). Results: there was no significant difference in the general situation between the two groups, and there was comparability between the two groups. There was no significant difference in PT,APTT,FIB,D- dimer and platelet content between the two groups at T1 point. At T2~T3 time point, PT in both groups was higher than that before operation, but there was no significant difference between the two groups. APTT in group A was significantly higher than that in group B while FIB, was significantly higher in group A than in group B. The levels of D-dimer and platelet in group B were significantly lower than those in group B (P < 0.05). There was no significant difference in MMSE scores between the two groups at time point T 1 and T 5, but MMSE score in group A was significantly higher than that in group B at the time point of T2~T4 (P < 0.05). Conclusion: compared with general anesthesia, epidural anesthesia in elderly orthopedic patients can not only significantly improve coagulation function, but also has less effect on postoperative cognitive function, and is more helpful to postoperative recovery.
【作者單位】： 北京市海淀醫(yī)院麻醉科;
【分類號】：R614

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