不同镇痛方式对食管癌根治术后患者凝血功能的影响*
Effect of different analgesia methods on blood coagulation in patients who underwent esophageal carcinoma surgery
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摘要: 目的:通过血栓弹力图(TEG )观察术后硬膜外和静脉自控镇痛对食管癌根治术后患者凝血功能的影响。方法:择期行食管癌根治术患者60例,随机双盲分为术后静脉自控镇痛(PCIA)组和术后硬膜外自控镇痛(PCEA)组,每组30例。观察术后6、12、24、48h 视觉模拟评分(VAS )并记录PCA 的总按压次数。分别于麻醉前(T 0)、术毕(T 1)、术后1d(T 2)、术后2d(T 3)、术后3d(T 4)测血小板计数(PLT),并行TEG 分析包括测定反应时间(R)、血凝块形成时间(K)、血凝块聚合形成速率(α 角)、最大振幅(MA)。 结果:1)PCEA 组患者在术后各时点的VAS 评分均低于PCIA组,PCA 总按压次数低于PCIA组(P < 0.05)。 2)PCEA 组不同时点R 值和K 值的变化与T 0 比较差异无统计学意义(P > 0.05),而在T 2、T 3、T 4 时点R 值和K 值分别较同一时点PCIA组显著延长(P < 0.05)。 PCEA 组在T 2、T 3、T 4 时点α 角和MA值分别与T 0 时点相比明显减小,并较同一时点PCIA组显著减小(P < 0.05)。 3)两组PLT 在T 2 和T 3 时点均较 T 0 时点显著降低。结论:食管癌根治术后行硬膜外自控镇痛效果优于静脉自控镇痛,并可一定程度改善患者高凝状态。Abstract: Objective: To investigate the effect of different analgesia methods on blood coagulation in patients who underwent esophageal carcinoma surgery through thrombelastography (TEG). Methods:A total of 60patients who underwent radical esophagecto -my were randomly divided into the patient- controlled epidural analgesia (PCEA) group and patient- controlled intravenous analgesia (PCIA) group with 30cases each. The visual analogue scale (VAS) and patient-controlled analgesia (PCA) bottom pressing times were recorded at 6, 12, 24, and 48h after surgery. The TEG parameters were measured at the time before anesthesia (T0), the end of surgery (T 1), first day after operation (T 2), second day after operation (T 3), and third day after operation (T 4). Results: (1) Compared with the PCIA group, the VAS scores and PCA bottom pressing times were significantly lower ( P<0.05). (2) The R and K values of the PCEA group had no significant difference compared with T 0 (P>0.05), and were significantly prolonged than those in the PCIA group at T 2, T3, and T 4 (P<0.05). (3) The platelet amount of the two groups decreased at T 2 and T3 compared with that at T 0 (P<0.05). Conclu-sion:The analgesic effect of PCEA was better than that of PCIA in patients who underwent esophageal carcinoma surgery, and may im-prove their hypercoagulability.
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期刊类型引用(5)
1. 梁广明,陈曼莉,温嘉筠,唐有华. 硬膜外自控镇痛对老年胸外科手术患者术后疼痛及呼吸功能的影响探究. 黑龙江医学. 2022(01): 11-13 . 百度学术
2. 亚森江·麦麦图尔迪,张力为. 食管癌患者围术期静脉血栓发生情况及危险因素分析. 中外医学研究. 2020(11): 129-131 . 百度学术
3. 张立勇,张艳,罗孔亮. 复方苦参注射液联合舒芬太尼对晚期癌症患者镇痛疗效、抗肿瘤因子水平及不良反应发生率的影响. 现代医学. 2020(10): 1315-1318 . 百度学术
4. 梁磊. 肋间神经阻滞改善老年食管癌患者术后疼痛及对认知障碍的临床影响. 世界华人消化杂志. 2018(10): 609-615 . 百度学术
5. 耿秀娟. 不同麻醉和镇痛方法对食道癌手术患者细胞免疫功能及应激激素水平的影响. 中国医学工程. 2018(03): 27-31 . 百度学术
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