采用血栓弹力图评估不同麻醉方式对膝关节置换术患者血液凝固动态变化的影响

目的  采用血栓弹力图来评估不同麻醉方式对膝关节置换术患者围手术期凝血功能的影响，为临床选择更佳的麻醉方式提供依据。方法  选取2013年12月-2015年9月中南大学湘雅医院入院治疗的188例单膝关节置换术患者进行研究。随机分为两组，各94例。对照组采用全身麻醉，观察组采用神经阻滞麻醉，分别在手术前、手术中以及手术后取静脉血测定血栓弹力图，指标包括凝固时间（k）、凝血活酶生成时间（r）、血栓最大值（MA）、凝固角（α）、凝血综合指数（CI）和血栓最大值确定后30 min内血凝块幅度减少速率（LY30）。结果与手术前和手术中比较，全身麻醉组r、k明显降低，α、MA、CI和LY30明显升高，差异有统计学意义（P = 0.003），而神经阻滞麻醉组仅有LY30有明显升高，差异有统计学意义（P =0.023）；在手术后两组参数比较中，神经阻滞麻醉组患者的r明显高于全身麻醉组，α、MA、LY30和CI均明显低于全身麻醉组，差异有统计学意义（P =0.006），与全身麻醉组比较，观察组的k值也有升高的趋势，但差异无统计学意义（P =0.086）；手术后对照组发生深静脉血栓（DVT）的比例为10.6%，观察组DVT的比例为0%，差异有统计学意义（P =0.030）。 结论  手术后患者的凝血功能明显发生变化，其中全身麻醉具有明显促进凝血的效应，相比之前，神经阻滞麻醉可以逆转这种凝血效应，并且患者发生DVT的比例更低，值得临床推广应用。

Evaluation of different anesthesia methods on coagulation function in knee replacement patients during perioperative period using thrombelastography

Objective To evaluate the different anesthesia on coagulation function in knee replacement patients during the perioperative period using thrombelastography, to provide evidence for clinical anesthesia. Methods A total of 188 cases from December 2013 to September 2015 in our hospital of single knee replacement were studied and they were randomly divided into two groups, each of 94 cases. The control group was administered with general anesthesia, the observation group was administered with nerve block anesthesia, the coagulation time(k), thromboplastin generation time (r), the maximum value of thrombosis (MA), the solidification angle (α), a comprehensive coagulation index (CI) and LY30 were measured in the test. Results Compared with pre-surgery and surgery, the r, k decreased significantly, meanwhile α, MA, CI and LY30 in the general anesthesia group were significantly increased, the difference was statistically significant (P = 0.003), and LY30 in the nerve block anesthesia group was rised significantly, the difference was statistically significant (P = 0.023). when the parameters after surgery were compared in the two group, the r of nerve block anesthesia group was significantly higher, while the α, MA, LY30 and CI were lower than the general anesthesia group, the difference was statistically significant (P = 0.006), the k value of the observation group also had increased, but the difference was not statistically significant (P = 0.086). The ratio of postoperative deep vein thrombosis in the control group (DVT) was 10.6% and the proportion of the observation group DVT was 0%, difference was statistically ignificant (P = 0.030). Conclusions The coagulation after surgery in patients is significant changed where general anesthesia has significantly promote clotting effect, and compared to before, nerve block anesthesia can reverse this effect blood clotting, and lower proportion of DVT.