[1]雷　震.3种麻醉方法在类风湿性关节炎患者全膝关节置换术中的应用效果比较[J].新乡医学院学报,2016,33(12):1074-1077.[doi:10.7683/xxyxyxb.2016.12.015]
　LEI Zhen.Comparison of the effect of three anesthesia for total knee replacement in patients with rheumatoid arthritis[J].Journal of Xinxiang Medical University,2016,33(12):1074-1077.[doi:10.7683/xxyxyxb.2016.12.015]
点击复制

3种麻醉方法在类风湿性关节炎患者全膝关节置换术中的应用效果比较
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
33
期数:
2016年12
页码:
1074-1077
栏目:
临床研究
出版日期:
2016-12-05

文章信息/Info

Title:
Comparison of the effect of three anesthesia for total knee replacement in patients with rheumatoid arthritis
作者:
雷　震
（武汉六七二中西医结合医院麻醉科，湖北　武汉　430079）
Author(s):
LEI Zhen
(Department of Anesthesia,Wuhan 672 Integrated Traditional Chinese and Western Medicine Hospital,Wuhan 430079,Hubei Province,China)
关键词:
硬膜外麻醉; 静脉麻醉; 全膝关节置换术; 深静脉血栓形成; 类风湿性关节炎
Keywords:
epidural anesthesia; intravenous anesthesia; total knee replacement; deep vein thrombosis; rheumatoid arthritis
分类号:
R593.21
DOI:
10.7683/xxyxyxb.2016.12.015
文献标志码:
A
摘要:
目的　比较连续硬膜外麻醉（CEA）、全身麻醉（GA）及CEA复合小剂量咪达唑仑和芬太尼静脉麻醉在类风湿性关节炎（RA）患者全膝关节置换术（TKR）中的应用效果。方法　选择2010年1月至2015年8月在武汉六七二医院行TKR的RA患者90例，根据麻醉方法分为CEA组、GA组和复合麻醉（CA）组（CEA复合小剂量咪达唑仑和芬太尼静脉麻醉），每组30例。分别于麻醉前(T0)、麻醉后6 h（T1)、术后24 h(T2)记录3组患者的平均动脉压（MAP）、心率（HR）和脑电双频指数（BIS），于术后24 h检测血浆纤维蛋白原（FIB）、D-二聚体（D-D）水平和血浆抗X因子活性峰值。所有患者术后随访3个月，观察下肢深静脉血栓形成（DVT）发生情况。结果　T0时3组患者MAP、HR及BIS比较差异均无统计学意义（P>0.05）；T1和T2时，GA组和CA组患者MAP、HR及BIS均显著低于CEA组（P<0.05），但GA组与CA组患者MAP、HR及BIS比较差异均无统计学意义（P>0.05）。术后24 h，3组患者血浆FIB、D-D水平及抗X因子活性峰值比较差异均有统计学意义（P<0.05）；CA组和CEA组患者血浆FIB、D-D水平显著低于GA组（P<0.05），CA组和CEA组患者抗X因子活性峰值显著高于GA组（P<0.05）；CA组与CEA组患者血浆FIB、D-D水平及抗X因子活性峰值比较差异均无统计学意义（P>0.05）。GA组、CEA组和CA组患者下肢DVT发生率分别为20.0%（6/30）、3.3%（1/30）和3.3%（1/30），CEA组和CA组患者下肢DVT发生率显著低于GA组（P<0.05）。结论　行TKR的RA患者采用CEA复合小剂量咪达唑仑和芬太尼静脉麻醉可获得良好的麻醉效果，可稳定患者血流动力学，且对凝血功能影响较小。
Abstract:
Objective　To compared the effect of continuous epidural anesthesia(CEA),general anaesthesia(GA),CEA combined with small dose of midazolam and fentanyl for total knee replacement(TKR)in patients with rheumatoid arthritis(RA).Methods　A total of 90 RA patients who underwent TKR in Wuhan 672 Integrated Traditional Chinese and Western Medicine Hospital from January 2010 to August 2015 were selected.The patients were divided into CEA group,GA group and combined anesthesia(CA)group(CEA combined with small dose of midazolam and fentanyl)according to anesthetic methods,30 cases in each group.The mean arterial blood pressure(MAP),heart rate(HR)and bispectral index(BIS)were recorded at the time points of before anesthesia(T0),6 hours after anesthesia(T1)and 24 hours after operation(T2)in the three groups.The levels of plasma fibrinogen(FIB),D dimmer(D-D)and the peak of Anti-X factor activity were detected 24 hours after operation.All patients were followed up for 3 months,and the occurrence of deep vein thrombosis(DVT) in lower limb was observed.Results　There was no significant difference in the MAP,HR and BIS in the three groups at the time point of T0(P>0.05).The MAP,HR and BIS in GA group and CA group were significantly lower than those in CEA group at the time point of T1 and T2(P<0.05);but there was no significant difference in the MAP,HR and BIS between GA group and CA group at the time point of T1 and T2(P>0.05).There were significant differences in the levels of plasma FIB,D-D and the peak of anti-X factor activity in the three groups at the time point of 24 hours after operation(P<0.05).The levels of plasma FIB and D-D in CA group and CEA group were significantly lower than those in GA group(P<0.05).The peak of anti-X factor activity in CA group and CEA group was significantly higher than that in GA group(P<0.05);there was no significant difference in the levels of plasma FIB,D-D and the peak of anti-X factor activity between CA group and CEA group(P>0.05).The lower limb DVT incidence in GA group,CEA group and CA group was 20.0%(6/30),3.3%(1/30)and 3.3%(1/30)respectively;the lower limb DVT incidence in CEA group and CA group was significantly lower than that in group GA(P<0.05).Conclusion　CEA combined with small dose of midazolam and fentanyl for TKR in patients with RA can obtain the good effect of anesthesia,stabilize the hemodynamics,and has little effect on the coagulation function.

参考文献/References:

［1］　乔志，王义生，殷力.全髋及全膝关节置换后下肢深静脉血栓形成的季节因素［J］.中国组织工程研究，2014，18（13）：2000-2005.
［2］　蔡猛，徐海斌.人工膝关节置换术后深静脉血栓形成的研究进展［J］.新乡医学院学报，2014，31（3）：232-235.
［3］　李云龙，王华，叶慧仪，等.不同麻醉方法对下肢骨关节手术患者围术期凝血功能的影响［J］.中国现代药物应用，2013，7（8）：9-11.
［4］　DA CORTE F C,NEVES N.Cervical spine instability in arthritis［J］.Eur J Orthop Surg Traumatol,2014,24(Suppl 1):S83-S91.
［5］　BISSAR L,ALMOALLIM H,ALBAZLI K,et al.Perioperative managemengt of patients with rheumatic disease［J］.Open Rheumatol J,2013,7:42-50.
［6］　高玉华，马涛.关节置换术患者椎管内麻醉和全身麻醉术后并发症发生情况比较的Meta分析［J］.中华麻醉学杂志，2010，30（4）：406-408.
［7］　任姜栋，张晓岗，曹力.重度膝关节外翻畸形的全膝关节置换术［J］.中华骨科杂志，2014，34（6）：645-651.
［8］　陈学青，贾健.直接Xa因子抑制剂预防全膝关节置换后深静脉血栓的Meta分析［J］.中国组织工程研究，2013，17(17)：3140-3147.
［9］　梁亚霞，刘晓伟，黄俊霞，等.小剂量布比卡因在高龄患者髋关节周围手术中的临床观察［J］.风湿病与关节炎，2013，2（3）：27-28.
［10］　贾科江，杨朝垒，马国涛，等.人工全膝关节置换术治疗类风湿性关节炎的疗效分析［J］.临床骨科杂志，2014，17（6）：677-679.
［11］　梁亚霞，徐向峰，黄俊霞.类风湿关节炎患者膝关节表面置换术的麻醉处理［J］.风湿病与关节炎，2013，2（8）：36-37.
［12］　AVINA-ZUBIETA J A,ABRAHAMOWICZ M,DE VERA M A,et al.Immediate and past cumulative effects of oral glucocorticoids on the risk of acute myocardial infarction in rheumatoid arthritis:a population-based study［J］.Rheumtology(Oxford),2013,52(1):68-75.
［13］　GANNA S.The prevalence of anemia in rheumatoid arthritis［J］.Rev Bras Reumatol,2014,54(4):257-259.
［14］　WASINEE K,SUMANA M,SURASAK N.Interferon-gamma induced nitric oxide-mediated apoptosis of anemia of chronic disease in rheumatoid arthritis［J］.Rheumatol Int,2013,33(1):151-156.

相似文献/References:

[1]郭纪生,王顺贞,张玉凤.可乐定对利多卡因硬膜外麻醉作用的影响[J].新乡医学院学报,2002,19(04):287.
[2]江培颜.全身麻醉与硬膜外麻醉对老年骨科手术患者短期认知功能的影响 [J].新乡医学院学报,2014,31(08):662.[doi:10.7683/xxyxyxb.2014.08.023]
[3]曹雅军,吴文春,董敏,等.不同硬膜外麻醉方案对初产妇疼痛和产后盆底功能的影响[J].新乡医学院学报,2023,40(12):1146.[doi:10.7683/xxyxyxb.2023.12.009]
　CAO Yajun,WU Wenchun,DONG Min,et al.Effects of different epidural anesthesia regimens on pain and postpartum pelvic floor function of primiparas[J].Journal of Xinxiang Medical University,2023,40(12):1146.[doi:10.7683/xxyxyxb.2023.12.009]

更新日期/Last Update: 2016-12-05