静脉自控镇痛和硬膜外自控镇痛对直肠癌术后患者血小板活化的影响

目的研究分析静脉自控镇痛（PCIA）和硬膜外自控镇痛（PCEA）对直肠癌术后患者血小板活化的影响及意义。方法以解放军第九四医院麻醉科近期收治的46例行直肠癌手术的为研究对象，随机分为两组，每组各23例。实验组患者术后给予PCEA，对照组患者术后给予PCIA，观察对比两组患者术后的血小板活化情况。结果实验组患者术后24、48hCD62P、CD63的表达水平以及CD41／CD61比值较术后即刻均有明显下降（P〈0．05）；对照组患者术后24hCD41／CD61比值较术后即刻明显降低，术后48hCD62P、CD63的表达水平以及CD41／CD61比值较术后即刻明显下降（P〈0．05）；实验组术后24、48hCD62P的表达水平以及CD41／CD61比值均明显低于对照组，术后48hCD63表达水平明显低于对照组（P〈0．05）；实验组术后24、48h活化的部分凝血活酶时间以及凝血酶原时间明显长于对照组，差异具有统计学意义（P〈0．05）。结论PCEA可以抑制血小板的活化，显著改善直肠癌患者术后全身血液的高凝状态，对深静脉血栓的产生具有预防意义，效果优于PCIA。

Effect of PCIA versus PCEA on platelet activation in patients undergoing rectum cancer operation

Objective To investigate the effect of PCIA versus PCEA on platelet activation in patients undergoing rectum cancer operation. Methods 46 patients undergoing rectum cancer operation were randomly divided into two groups, each with 23 patients, The experimental group received the PCEA while the control group received the PCIA. The platelet activation were observed in the two group. Results The expression levels of CD62P,CD63 and CD41/ CD61 postoperative 24 h, 48 h in the experimental group were significantly lower than that immediate postoperative （P 〈 0.05）. The CD41/CD61 postoperative 24 h in the control group was significantly lower than that immediate postoperative （P 〈 0.05）. The expression levels of CD62P, CD63 postoperative 48 h in the control group were significantly lower than that immediate postoperative （P 〈 0.05）. The expression levels of CD62P, CD63 and CD41/CD61 postoperative 24 h, 48 h in the experimental group were significantly lower than that in the control group （P 〈 0.05）. The APTr and PT postoperative 24 h, 48 h in the experimental group were significantly longer than that in the control group （P 〈 0.05）. Conclusion PCEA can inhibit the activation of platelet, significantly improve cancer patients＇ systemic blood hypercoagulable state and prevent the generation of DVT.