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目的:探讨全麻及全麻复合硬膜外麻醉对胃癌手术患者凝血功能的影响。方法:选择2013年1月~2015年12月我院收治的60例胃癌根治术患者,随机均分为全麻组(A组)及全麻复合硬膜外麻醉组(B组)。对比两组患者的术后恢复情况、T0(术前)、T1(术毕)、T2(术后24 h)、T3(术后72 h)的血浆纤维蛋白原(FIB)、凝血酶时间(TT)、血浆凝血酶原时间(PT)、部分活化凝血酶时间(APTT)、血小板计数(PLT)及血栓素B2(TXB2)值。结果:B组的清醒时间、自主呼吸恢复时间、拔管时间及异丙酚维持麻醉用量明显低于A组(P分别为0.044、0.036、0.042);与T0相比,B组PT、APTT在T2、T3时明显延长(P<0.05),A组及B组的FIB在T2、T3时明显升高(P<0.05),而B组明显低于A组(P<0.05);与T0相比,两组PLT在T2、T3点时明显降低(P<0.05),且A组明显低于B组(P<0.05);两组TXB2在T2、T3点时明显升高(P<0.05),且A组明显高于B组(P<0.05)。结论:全麻复合硬膜外麻醉效果确切,可以减少对患者凝血系统的影响,预防术后血栓性疾病的发生,值得临床推广应用。
Objective: To investigate the effects of general anesthesia and general anesthesia combined with epidural anesthesia on coagulation in patients with gastric cancer. Methods: Sixty patients undergoing radical gastrectomy in our hospital from January 2013 to December 2015 were randomly divided into general anesthesia group (A group) and general anesthesia combined epidural anesthesia group (B group). The postoperative recovery of T0 (preoperative), T1 (operative), T2 (postoperative 24 h), T3 (postoperative 72 h), fibrinogen (FIB), thrombin time TT, PT, APTT, PLT and TXB2 were measured. Results: The awake time, spontaneous breathing recovery time, extubation time and propofol maintenance anesthesia in group B were significantly lower than those in group A (P = 0.044, 0.036,0.042, respectively). Compared with T0, PT and APTT in group B were (P <0.05). The FIB of A group and B group were significantly increased at T2 and T3 (P <0.05), while that of B group was significantly lower than that of A group (P <0.05) (P <0.05), and the levels of PLT in both groups were significantly lower than those in group B (P <0.05) at the T2 and T3 points. The levels of TXB2 in the two groups were significantly increased at T2 and T3 (P <0.05) , And group A was significantly higher than group B (P <0.05). Conclusion: The effect of general anesthesia combined with epidural anesthesia is exact, which can reduce the influence on coagulation system of patients and prevent the occurrence of postoperative thrombotic diseases, which is worthy of clinical application.