不同麻醉方法对剖宫产围术期凝血功能及 D-二聚体水平的影响解析

・论著・

不同麻醉方法对剖宫产围术期凝血功能

及D-二聚体水平的影响

孔松泉 包丽霞 蒋淑芬

322300浙江省磐安县人民医院麻醉科(孔松泉、包丽霞),妇产科(蒋淑芬)

DOI:10.3760/cma.j.issn.1008-6706.2016.05.034

  【摘要】 目的 探讨不同麻醉方法对剖宫产围术期凝血功能及D-二聚体(D-D)影响,为临床麻醉方式提供参考。方法 选择120例剖宫产产妇,按照麻醉方式分为观察组与对照组。观察组70例实施腰硬联合麻醉,对照组50例实施硬膜外麻醉,比较两组凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fbg)、D-D、镇痛效果及并发症等临床指标。结果 观察组与对照组术前PT、APTT、TT、Fbg组间差异无统计学意义(P>0.05);观察组术后6h、术后24hPT、APTT、TT分别为(13.23±1.86)s、(31.18±5.94)s、(15.52±2.55)s,(12.85±1.94)s、(29.74±5.52)s、(14.68±3.15)s,均低于对照组,差异有统计学意义(t=3.294、4.546、4.143、3.656、3.435、3.115,均P<0.05),术后6h观察组Fbg[(3.17±0.48)g/L]低于对照组,差异有统计学意义(t=3.656,P<0.05);观察组D-D术前、术后即刻、术后24h分别为(0.28±0.04)mg/L、(0.33±0.07)mg/L、(0.33±0.07)mg/L,术后相比术前略有上升,但组内对比、与对照组差异均无统计学意义(P>0.05);观察组术后疼痛2级、3级发生率分别为41.43%、30.00%,与对照组术后疼痛评级差异均无统计学意义(P>0.05);观察组术后未发现深静脉血栓,对照组确诊1例股静脉血栓形成,两组静脉血栓发生率差异无统计学意义(P>0.05)。结论 腰硬联合麻醉、硬膜外麻醉均可预防剖宫产围术期血液高凝状态,降低血栓性并发症发生率,腰硬联合麻醉是首选方法。

【关键词】 麻醉; 剖宫产; 凝血功能; D-二聚体

ClinicalinvestigationofeffectofdifferentanesthesiaoncesareansectionperioperativecoagulationfunctionandD-dimer KongSongquan,BaoLixia,JiangShufen.

DepartmentofAnesthesia,thePeople′sHospitalofPananCounty,Zhejiang322300,China(KongSQ,BaoLX);DepartmentofObstetricsandGynecology,thePeople′sHospitalofPananCounty,Zhejiang322300,China(JiangSF)  【Abstract】 Objective Toinvestigateeffectofdifferentanesthesiaoncesareansectionperioperativecoagula-tionfunctionandD-dimer,toprovideareferenceforclinicaltreatment.Methods 120casesofcesareansectionpatientswereselected,accordingtotheanesthesiatheyweredividedintoobservationgroupandcontrolgroup.Obser-vationgroup(70cases)usedcombinedspinalepiduralanesthesia,thecontrolgroup(50cases)usedepiduralanes-thesia.Theprothrombintime(PT),activatedpartialthromboplastintime(APTT),thrombintime(TT),fiberclinicalindicatorsfibrinogen(Fbg),DD,analgesiaanditscomplicationswerecomparedbetweenthetwogroups.ResultsBeforesurgery,PT,APTT,TT,Fbghadnostatisticallysignificantdifferencesbetweenthetwogroups(P>0.05).6h,24hafteroperation,PT,APTT,TToftheobservationgroupwere(13.23±1.86)s,(31.18±5.94)s,(15.52±2.55)s;(12.85±1.94)s,(29.74±5.52)s,(14.68±3.15)s,whichwerelowerthanthecontrolgroup,thediffer-enceswerestatisticallysignificant(t=3.294,4.546,4.143,3.656,3.435,3.115,allP<0.05).6hafteroperation,Fbgoftheobservationgroupwas(3.17±0.48)g/L,whichwaslowerthanthecontrolgroup,thedifferencewasstatis-ticallysignificant(t=3.656,P<0.05);D-Doftheobservationgroupbeforesurgery,immediatelyaftersurgery,24haftersurgerywere(0.28±0.04)mg/L,0.04mg/L,(0.33±0.07)mg/L,(0.33±0.07)mg/L,comparedwiththecontrolgrouphadnostatisticallysignificantdifferences(P>0.05).Intheobservationgroup,theincidenceratesofpainlevel2,3were41.43%,30.00%,comparedtothecontrolgroupshowednosignificantdifference(P>0.05).Deepveinthrombosiswasnotfoundintheobservationgroup,thecontrolgroupconfirmedonecaseoffemoralveinthrombosis,theincidenceofvenousthrombosisinthetwogroupsshowednosignificantdifference(P>0.05).Conclusion Combinedspinalepiduralanesthesia,epiduralanesthesiacanbothpreventcesareansectionpatientsfromperioperativehypercoagulablestate,reducetheincidenceofthromboticcomplications,epiduralanesthesiaisthepreferredmethod.【Keywords】 Anesthesia; Cesareansection; Coagulation; D-dimer・

567・中国基层医药2016年3月第23卷第5期 ChinJPrimMedPharm,March2016,Vol.23,No.5

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