硬膜外腔吗啡对全髋置换术围手术期D-二聚体的影响

目的 研究阿片类药物硬膜外腔持续注射对全髋置换手术围术期D-二聚体的影响。方法选择40例择期全髋关节置换手术患者，随机分成两组。吗啡组：手术开始前15min于硬膜外腔给予吗啡4mg＋0．9％生理盐水10ml，术毕硬膜外腔吗啡80μg／h持续给药48h；对照组：术前15min给予0．9％生理盐水10ml，术毕硬膜外腔给予0．15％罗哌卡因2．0ml／h持续给药48h。分别于麻醉前5min、术毕、术后24h、术后48h4个时点抽取静脉血测定血浆IL-6、D-二聚体含量和凝血酶原时间。结果两组患者术毕、术后24、48h的IL-6、D-二聚体含量较麻醉前均显著升高（P〈0．01），术毕时达到峰值，随后逐渐回落。吗啡组患者术毕、术后24、48h时间点IL-6、D-二聚体含量均显著低于对照组（P〈0．05）；硬膜外腔注射吗啡对围手术期凝血酶原时间和出血量均无明显影响。结论硬膜外腔注射吗啡可抑制凝血系统的过度激活．减少D-二聚体的生成，改善围术期高凝状态。

Effect of perioperative continuous epidural morphine administration on plasma D-dimer in patients undergoing total hip replacement

OBJECTIVE: To evaluate the effect of perioperative continuous epidural morphine administration on plasma D-dimer level in patients undergoing total hip replacement. METHODS: Forty ASA I-II patients undergoing total hip replacement under epidural anesthesia were randomized into two groups. In one group, the patients were given epidural administration of morphine 15 min before operation at 4 mg (in 10 ml normal saline) and for 48 h after the operation at 80 microg/h, while those in the other group received epidural injection of the same amount of normal saline before operation and 0.15% ropivacaine 2.0 ml/h for 48 h in the same manner after operation. Blood samples were taken before anesthesia (T(0)), at the end of operation (T(1)), and 24 h and 48 h after operation (T(2) and T(3)) for determination of plasma IL-6 and D-dimer levels. RESULTS: In both groups plasma IL-6 and D-dimer levels showed significant increase at T(1), T(2) and T(3) in comparison with those at T(0), and their levels were significantly lower in morphine group than in ropivacaine group at T(1), T(2) and T(3). CONCLUSION: Epidural morphine can lower plasma IL-6 and D-dimer levels and correct blood hypercoagulability in patients undergoing total hip replacement.