全麻复合硬膜外麻醉对胃癌根治术围术期纤溶功能的影响

目的:探讨全身麻醉复合连续硬膜外麻醉对胃癌根治患者围术期纤溶功能的影响。方法:选择2013年4月到2015年6月在我院进行胃癌根治手术的患者80例,根据随机数字表法分为治疗组40例与对照组40例,对照组给予全身麻醉,治疗组给予全身麻醉复合连续硬膜外麻醉,对两组患者血流动力学指标,纤溶功能以及下肢深静脉血栓发生情况进行观察与比较。结果:所有患者都完成手术,诱导后患者的MAP与HR值与诱导前比较差异都有统计学意义(P0.05),不过组间对比无显著性差异(P0.05),术毕MAP与HR值在组内与组间比较均无显著性差异(P0.05)。治疗组诱导后5 min与术毕的血清D-二聚体和纤维蛋白原值都明显低于对照组,且与诱导前对比差异也有统计学意义(P0.05)。治疗组术后下肢深静脉血栓发生率明显低于对照组(P0.05)。结论:全身麻醉复合连续硬膜外麻醉能改善胃癌根治患者围术期纤溶功能,从而减轻患者高凝状态,安全性好,有效预防下肢深静脉血栓的形成。

Effects of General Anesthesia Combined with Epidural Anesthesia on Perioperative Fibrinolysis for Patients with Gastric Cancer

Objective:To investigate the effects of general anesthesia combined with epidural anesthesia on perioperative fibrinolysis function for patient with gastric cancer.Methods:From April 2013 to June 2015 in our hospital, 80 patients with gastric cancer who needed radical surgery were selected and equally divided into treatment group and control group, 40 patients each group. The patients in control group were given general anesthesia, and the patients in treatment group were given general anesthesia combined with epidural anesthesia. Then the indexes of haemodynamics, fibrinolytic function and the incidence of deep vein thrombosis of two groups were observed and compared.Results:All patients were completed the surgery, and the MAP and HR values in the patient after induction were statistically significant differences compared with before induction (P <0.05), but had no significant difference in comparison between the two groups (P>0.05), and the MAP and HR values after surgery were showed no significant difference in comparison within the group and between the two groups (P>0.05). The serumD- dimer and fibrinogen values in the times of induction 5 min and after surgery in the treatment group were significantly lower than that of the control group, and the differences were statistically significant compared with before induction (P<0.05). The incidence of deep vein thrombosis was 5.0%in the treatment group, and 17.5 %in the control group, and it was significantly lower in the treatment group than that of the control group (P<0.05).Conclusion:General anesthesia combined with epidural anesthesia in operative treatment of gastric cancer patients can improve perioperative fibrinolysis, thus reduce patients'' hypercoagulable state, has good security and can effectively prevent the formation of deep vein thrombosis.