七氟醚对肝癌患者围术期凝血功能的影响

摘要

Objective To observe the effect of sevoflurane anesthesia on perioperative coagulation function in patients with liver cancer. Methods Forty patients of ASA Ⅱ ~Ⅲ and Child-Pugh A~B liver cancer scheduled for hepatectomy were randomly divided into two groups: sevoflurane (group S) and isoflurane group (group Ⅰ), each with 20 cases. The patients were pretreated with atropine 0.5 mg and luminal sodium 0.1 g. Anesthesia was induced with hydrochloric acid dexmedetomidine 0.5 μg/kg, fentanyl 3~5 μg/kg, propofol 1.5~2.0 mg/kg, cisatracurium 0.2~0.3 mg/kg. Mechanical ventilation was performed after tracheal intubation. Anesthesia was maintained with sevoflurane and isoflurane respectly in group S and group I (the end of the anesthetic gas concentration was maintained at 1 MAC) and intermittent iv boluses of fentanyl and cisatracurium after tracheal intubation. The venous blood were collected for detection of partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fiber and fibrinogen concentration (FIB), thromboelastogram (TEG). In addition, operation time and bleeding volume were recorded before onesthesia (To) and at the end of surgery (Ti). Results There were no statistically significant difference between the two groups in coagulation indicators and TEG parameters (R, K, alpha angle, MA, and CL30) at each time point. In group S, PT was higher at T, than To, while MA, FIB were lower. In group I, PT, APTT were higher at T1 than To, while FIB was lower. Conclusion Compared with isoflurane, sevoflurane has no significant effects on blood coagulation function and TEG parameters in patients with liver cancer.%目的 观察七氟醚麻醉对肝癌患者围术期凝血功能的影响.方法 40例ASAⅡ～Ⅲ级、Child-Pugh分级A～B级择期行肝癌切除术的患者随机分为两组,七氟醚(S组)和异氟醚组(Ⅰ组),每组20例.麻醉前30 min给予阿托品0.5 mg、鲁米那钠0.1g肌注,麻醉诱导采用静注盐酸右美托嘧啶0.5 μg/kg、芬太尼3～5μg/kg、丙泊酚1.5～2.0 mg/kg、顺苯磺酸阿曲库铵0.2～0.3 mg/kg,气管插管后行机械通气.S组和Ⅰ组的麻醉维持分别采用七氟醚和异氟醚吸入,麻醉气体呼末浓度维持在1 MAC左右.分别于麻醉诱导前(T0)、手术结束即刻(T1)两个时点检测部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原浓度(FIB)、血栓弹性描记图(Thromboelastogram,TEG),并记录手术时间、出血量等.结果 两组患者各时点凝血指标及TEG参数(R、K、α角、MA和CL30)变化的组间比较差异无统计学意义.与To时比较,T1时七氟醚组PT增高,Fib、MA降低；异氟醚组PT增高,Fib降低,APTT增高.结论 与异氟醚相比,七氟醚对肝癌患者围术期凝血指标和TEG参数无明显影响.