Objective :To study the influences of different anesthesia techniques on stress response, coagulation and fibrinolytic function. Methods: Thirty patients undergoing hysterectomy were randomized into three groups: Group E ( continuous epidural anesthesia, n = 10) , Group G + E ( epidural anesthesia combined general anesthesia, n = 10 ) and Group G (general anesthesia, n = 10 ). The blocking level with epidural anesthesia was maintained between T6 - L3 with 0.75% bupivacaine followed by PatientControlled Epidural Analgesia (PCEA). General anesthesia was finished with convention followed by Patient-Controlled Analgesia (PCA). Blood samples were taken at pre-anesthesia (T0 ) , the end of operation ( T1 ) and postoperative 24 h (T2 ), 72 h ( T3 ) to determine catecholamine concentration, coagulation and fibrinolysis variables. Results: The nonepinephrine (NE) levels in Group E and Group G + E were not changed throughout the procedure, but obviously elevated in Group G (P <0.01 ) as compared with the baseline and those in the other Groups ( P < 0.05 ). The epinephrine (E) levels at T1 in all groups were markedly increased as compared with those at T0 and peaked (P <0.01 ), and then returned to the baseline at T3. Fibrinogen (FIB) levels in all groups were obviously decreased at T1, postoperatively elevated rapidly and peaked at T3 (P < 0.01 ). FIB levels at T3 in groups G + E and G were much higher than that in Group E (P <0.05 ). The thrombin-anti-thrombin Ⅲ complex (TAT) levels at T1 in Group G + E and G were significantly increased as compared with those at Group E ( P < 0.01 ), and subsequently recovered to pre-anesthesia following surgery. TAT level in Group E was more decreased postoperatively than the baseline and those in the other groups (P < 0.05 ). The D-dimer level in Group E over time was remarkably increased as compared with the baseline ( P < 0.05 ), and the D-dimer levels peaked at T2 in all groups (P <0.01 ). The tissue-type plasminogen activator (t-PA) was more elevated than T0 at T1 (P <0.01 ) in all groups, and then returned to normal in Group E. But the marked decrease of t-PA in Groups G + E and G was revealed 72 h after surgery and became much lower than that in Group E (P <0.01 ). The plasminogen activating inhibitor-1 (PAI-1) in Group G and Group G + E was more elevated perioperatively and became higher than that in Group E (P < 0.01 ). Conclusion: Epidural anesthesia can preserve fibrinolytic function after lower-abdomen surgery by the inhibitory effects on surgical stress, PAI-1 and other mechanisms. The thromboprophylactic effects are revealed only following epidural anesthesia.%目的:研究不同麻醉方式对应激反应、凝血和纤溶功能的影响.方法:实施全子宫切除的30例患者随机分为3组:连续硬膜外麻醉组(组E,n=10),硬膜外麻醉联合全身麻醉组(G+E,n=10)和单纯全麻组(G组,n=10).硬膜外麻醉的阻滞平面采用7.5g/L的布比卡因维持在T6到L3,术后行患者自控硬膜外镇痛(PCEA),全身麻醉采用常规方法完成,术后行患者自控性镇痛(PCA).分别在麻醉前(T0)、术毕(T1)和术后第24小时(T2)、第72小时(T3)采集血样测定儿茶酚胺浓度、凝血和纤溶参数.结果:E组和G+E组患者的去甲肾上腺素(NE)水平在围术期没有明显变化,但在G组患者却显著高于基线值(P<0.01)和其它两组患者(P<0.05).在T1时,3组患者的肾上腺素水平均明显高于T0并达到峰值(P<0.01),然后在T3恢复正常.3组患者的纤维蛋白原水平(FIB)在T1明显降低(P<0.01),但术后快速升高并在T3达到最高(P<0.01).在T3时G+E组和G组患者的FIB水平明显高于E组患者(P展开▼
