全身麻醉复合硬膜外麻醉对开胸手术患者血栓素A2、血浆D二聚体及应激氧化相关指标的影响

目的探讨全身麻醉复合硬膜外麻醉对开胸手术患者血栓素A2(TXA2)、血浆D二聚体(D-D)等纤溶功能及应激氧化相关指标的影响。方法选取择期行开胸手术的患者240例,按麻醉方法分为硬膜复合组(n=120)与静吸复合组(n=120),前者实施硬膜外复合全身麻醉,后者实施静吸复合全身麻醉。密切观察两组患者外周静脉血检测纤溶功能与应激氧化指标,包括TXA2、血浆D-D、组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制物(PAI-1)及去肾上腺素(NE)、肾上腺素(E)、多巴胺(DA)。结果两组术前各项纤溶功能指标、应激氧化指标比较无统计学意义(P0.05),两组术后各项纤溶功能指标、应激氧化指标均较术前显著升高(P0.05),但硬膜复合组术后TXA2、D-D、tPA、PAI-1升高幅度明显低于静吸复合组(P0.05),NE、E、DA升高幅度亦明显低于静吸复合组(P0.05)。结论与静吸复合全身麻醉相比,全身麻醉复合硬膜外麻醉对开胸手术患者纤溶功能影响更小,更有利于减轻氧化应激反应和提高麻醉恢复质量。

Effect of General Anesthesia Combined with Epidural Anesthesia on Thromboxane A2, Plasma D-dimer and Oxidative Stress Related Indicators in Patients Undergoing Thoracic Surgery

Objective To investigate the effect of general anesthesia combined with epidural anesthesia on thromboxane A2 ( TXA2 ) , plasma D-dimer ( D-D ) and fibrinolytic function and oxidative stress related indexes in patients undergoing thoracic surgery .Methods 240 patients undergoing thoracic surgery were divided into the epidural combined group ( n =120 ) and intravenous inhalation combined group ( n =120 ) according to the anesthesia methods .The former were given epidural anesthesia combined with general anesthesia while the latter were given intravenous inhalation combined with general anesthesia .The peripheral venous blood of both groups were collected before and after operation to detect the fibrinolytic function and oxidative stress related indexes , including TXA2, plasma D-D, tissue plasminogen activator ( t-PA ), plasminogen activator inhibitor(PAI-1),norepinephrine(NE)epinephrine(E)and dobaamine(DA).Results Before operation, the fibrinolytic function and oxidative stress related indexes showed no significant differences between the two groups ( P >0.05 ) .After operation , the indexes were significantly higher than those before operation(P<0.05),and the increased amplitudes of TXA2,D-D,t-PA,PAI-1,NE,E and DA in the epidural combined group were significantly lower than those in the intravenous inhalation combined group ( P <0.05 ) .Conclusion Compared with intravenous inhalation combined with general anesthesia , general anesthesia combined with epidural anesthesia has less effect on the fibrinolytic function in patients undergoing thoracic surgery , which is beneficial to reduce the oxidative stress and improve the quality of recovery from anesthesia .