本文選題：硬膜外麻醉　切入點(diǎn)：靜脈麻醉　出處：《中國(guó)骨與關(guān)節(jié)損傷雜志》2016年08期 　論文類型：期刊論文

【摘要】：目的探討硬膜外麻醉復(fù)合小劑量靜脈麻醉對(duì)類風(fēng)濕關(guān)節(jié)炎伴關(guān)節(jié)畸形行全膝關(guān)節(jié)置換術(shù)(TKA)患者術(shù)后下肢深靜脈血栓(DVT)形成的影響。方法自2010-01—2015-08共診治因類風(fēng)濕性關(guān)節(jié)炎伴關(guān)節(jié)畸形而行TKA的患者60例,按隨機(jī)數(shù)字法平均分為3組,術(shù)中分別采用連續(xù)硬膜外麻醉(A組)、靜-吸復(fù)合全身麻醉(B組)和硬膜外麻醉復(fù)合小劑量靜脈麻醉(C組),觀察3組DVT的發(fā)生率、術(shù)中血流動(dòng)力學(xué)和應(yīng)激功能指標(biāo)。結(jié)果 B組血漿纖維蛋白原和D-二聚體水平高于其他2組,而抗X因子活性峰值低于其他2組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。T0時(shí)間點(diǎn)3組血壓,心率和BIS值水平均無明顯差異,而T1和T2時(shí)間點(diǎn)B組血壓、心率、BIS值均顯著低于其他2組(P0.05);B組DVT發(fā)生率高于其他2組,差異有統(tǒng)計(jì)學(xué)意義(χ~2=13.2,P=0.01)。結(jié)論硬膜外麻醉復(fù)合小劑量靜脈麻醉可穩(wěn)定術(shù)中血流動(dòng)力學(xué),麻醉效果佳,降低下肢深靜脈血栓發(fā)生率,其機(jī)制與抑制凝血過程有關(guān)。
[Abstract]:Objective to investigate the effect of epidural anesthesia combined with low dose intravenous anesthesia on the formation of DVT in patients with rheumatoid arthritis with joint deformity after total knee arthroplasty. Methods the diagnosis and treatment of rheumatoid rheumatoid syndrome were performed from 2010-01-2015-08. TKA was performed in 60 patients with ganglitis associated with joint deformities. According to the random number method, the patients were divided into three groups: group A (continuous epidural anesthesia), group B (combined with general anesthesia) and group C (combined with epidural anesthesia and small dose intravenous anesthesia). The incidence of DVT in the three groups was observed. Results the plasma fibrinogen and D-dimer levels in group B were higher than those in the other two groups, but the peak value of anti-X factor activity was lower than that in the other two groups. There was no significant difference in heart rate and BIS, but the incidence of DVT in group B was significantly lower than that in group B at T 1 and T 2, which was significantly lower than that in group B (P 0.05) and the incidence of DVT in group B was higher than that in group B at T 1 and T 2, respectively. Conclusion epidural anesthesia combined with small dose intravenous anesthesia can stabilize hemodynamics during operation and reduce the incidence of deep venous thrombosis in lower extremity. The mechanism is related to the inhibition of coagulation.
【作者單位】： 當(dāng)陽長(zhǎng)坂坡醫(yī)院麻醉科;
【分類號(hào)】：R614

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