硬膜外腔麻醉对妊娠血小板减少症患者凝血功能的影响

目的:探讨硬膜外腔麻醉对妊娠血小板减少症患者凝血功能的影响。方法:选择陆军军医大学大坪医院麻醉科(我院)2018年6月至2019年6月收治的妊娠血小板减少症患者86例,按照随机数字表法分为研究组和对照组,每组各43例。研究组给予硬膜外腔麻醉,对照组给予全麻,观察和比较两组产妇麻醉前后凝血系统各项指标的变化情况。结果:研究组产妇在麻醉前、麻醉后0.5 h、术后0.5 h、术后24 h、术后48 h激活凝血酶时间(Activated partial thromboplastin time,APTT)长于对照组(P<0.05)。两组产妇麻醉后纤维蛋白原(Fibrinogen, FIB)和D-二聚体水平(D-dimer,D-D)较麻醉前显著升高,且对照组明显高于研究组(P<0.05)。两组产妇手术时间比较差异无统计学意义(P>0.05),研究组产妇术后平均出血量和术后24 h平均出血量均明显少于对照组(P<0.05)。两组新生儿出生1 min、5 min的Apgar评分比较差异无统计学意义(P>0.05)。结论:硬膜外腔麻醉对妊娠血小板减少症产妇的凝血功能影响较小,但麻醉起效快、效果确切,且可一定程度减少患者手术和术后出血量。

Effect of Epidural Anesthesia on the Coagulation Function of Patients with Pregnancy Thrombocytopenia

ABSTRACT Objective: To investigate the effect of epidural anesthesia on the coagulation function of patients with pregnancy thrombocytopenia. Methods: 86 patients with pregnancy-induced thrombocytopenia admitted to our hospital from June 2018 to June 2019 were enrolled in the study. According to the random number table method, divided into study group and control group, with 43 cases in each group. The study group was given epidural anesthesia, and the control group was given general anesthesia, the changes of various indicators of maternal coagulation system before and after anesthesia were observed and compared. Results: The APTT of the study group before the anesthesia, at 0.5 h after anesthesia, at 0.5 h, 24 h, and 48 h after surgery were longer than those of the control group (P<0.05). The levels of FIB and D-D in the two groups were significantly higher than those before anesthesia, which was significantly higher in the control group than that of the study group(P<0.05). There was no significant difference in the operation time between the two groups (P>0.05). The average blood loss and the average blood loss after 24 hours were significantly lower in the study group than in the control group (P<0.05). There was no significant difference in the Apgar scores between the two groups at 1 min and 5 min (P>0.05). Conclusion: Epidural anesthesia has little effect on the coagulation function of pregnant women with thrombocytopenia, but the anesthesia has a fast onset and effective effect, and can reduce the amount of surgery and postoperative bleeding to some extent.