Objective To explore the effect of general anesthesia combined with epidural anesthesia on coagulation function in patients undergoing orthopedic operation below hip.Methods Totally 120 patients undergoing orthopedic operation below hip from May 2013 to April 2015 were randomly divided into general anesthesia group,epidural anesthesia group and general anesthesia combined with epidural anesthesia group (combination group),40 cases in each groups.The duration of operation,intraoperative blood loss,transfusion volume and blood transfusion volume were recorded.The prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),fibrinogen (FBG) were measured before anesthesia (T0),1 h after anesthesia (T1),when the surgery was finished (T2),24 h after surgery (T3),48 h after surgery (T4).The incidence of complications were observed and compared among groups.Results The duration of operation,intraoperative blood loss,transfusion volume and blood transfusion volume were all not significantly different among three groups (P ＞ 0.05).At T2-T4 point,the PT were significantly longer than that at T0 point in general anesthesia group,epidural anesthesia group and combination group [(16.5 ± 2.5),(15.8 ± 1.8),(14.5 ± 1.8) s vs (13.2 ±2.8) s;(16.5 ±2.4),(15.9±1.8),(14.5 ±2.0) s vs (13.2 ±2.3) s;(16.3 ±2.4),(15.7±1.9),(14.5 ± 1.8) s vs (13.2 ±2.6) s];the APTT at T3 point were significantly longer than that at T0 point in general anesthesia group,epidural anesthesia group and combination group [(36 ± 7) s vs (32 ± 7) s;(36 ± 6) s vs (33 ±6) s;(36 ±6) s vs (32 ±7) s];the TT at T3,T4 point,were significantly longer than that at T0 point ingeneral anesthesia group,epidural anesthesia group and combination group [(13.5 ± 1.8),(12.1 ± 1.8) s vs (11.6±1.8) s;(13.5 ±1.8),(12.5 ±2.0) s vs (12.2±1.3) s;(13.7 ±1.9),(12.3 ±1.8) s vs (11.8 ± 1.6) s];the FBG at T2-T4 point were significantly lower than that at T0 point in epidural anesthesia group and combination group [(2.9 ±0.4),(2.8 ±0.4),(2.8 ±0.6) g/L vs (3.4 ±0.7) g/L;(2.8 ±0.5),(2.8 ± 0.4),(2.8 ± 0.7) g/L vs (3.2 ± 0.8) g/L] (P ＜ 0.05).The coagulant function indices were not significantly different at the rest time points in three groups (P ＞ 0.05).The incidence of postoperative complication general anesthesia group was significantly higher than that in epidural anesthesia group and combination group [10.0％ (4/40)vs0.0％ (0/40),0.0％ (0/40)] (P＜0.05).Conclusion General anesthesia combined with epidural anesthesia can effectively prevent the hypercoagulable state and reduce the incidence of perioperative thrombotic complication in patients undergoing orthopedic operation below hip.%目的 探讨全身麻醉联合硬膜外麻醉对髋部以下骨科手术患者凝血功能的影响.方法 选取2013年5月至2015年4月于湖北省黄石市中心医院行髋部以下骨科手术患者120例,根据随机数字表法分为全身麻醉组、硬膜外麻醉组及全身麻醉联合硬膜外麻醉组(联合组),各40例.记录3组患者手术时间、术中出血量、输液量和输血量.分别于麻醉前(T0)、麻醉后1 h(T1)、术毕(T2)、术后24 h(T3)、术后48 h(T4)采集患者静脉血检测凝血酶原时间(PT)、部分活化凝血酶原时间(APTT)、凝血酶时间(TT)和纤维蛋白原(FBG)含量.观察并比较3组患者并发症发生情况.结果 3组患者手术时间、术中出血量、输液量和输血量比较,差异均无统计学意义(均P ＞0.05).T2～T4时点,全身麻醉组、硬膜外麻醉组及联合组PT均明显长于T0时点[(16.5±2.5)、(15.8±1.8)、(14.5±1.8)s比(13.2±2.8)s,(16.5±2.4)、(15.9±1.8)、(14.5±2.0)8比(13.2±2.3)s,(16.3±2.4)、(15.7±1.9)、(14.5±1.8)s比(13.2±2.6)s];T3时点,3组APTT均长于T0时点[(36±7)s比(32±7)s,(36±6)比(33±6)s,(36±6)s比(32±7)s];T3、T4时点,3组TT均明显长于T0时点[(13.5±1.8)、(12.1±1.8)s比(11.6±1.8)s,(13.5±1.8)、(12.5±2.0)s比(12.2±1.3)s,(13.7±1.9)、(12.3±1.8)s比(11.8±1.6)s];T2 ～T4时点,硬膜外麻醉组和联合组FBG均明显低于T0时点[(2.9±0.4)、(2.8±0.4)、(2.8 s0.6) g/L比(3.4±0.7)g/L、(2.8±0.5)、(2.8±0.4)、(2.8±0.7) g/L比(3.2±0.8)g/L],差异均有统计学意义(均P＜0.05).3组其余各时点凝血功能指标比较,差异均无统计学意义(均P＞0.05).全身麻醉组术后并发症发生率高于硬膜外麻醉组及联合组[10.0％ (4/40)比0.0％ (0/40)、0.0％ (0/40)],差异有统计学意义(P＜0.05).结论 全身麻醉联合硬膜外麻醉能有效预防髋部以下骨科手术患者血液高凝状态,有利于减少围术期血栓性并发症的发生.
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