国际麻醉学与复苏杂志   2012, Issue (6): 0-0
    
围术期保温对老年患者止血功能的影响
洪彬源, 刘洪珍, 杨承祥, 黄腾, 伍辉萍, 蔡日生, 杨子文1()
1.广东省佛山市第一人民医院
Effect of perioperative thermal preservation on hemostatic function in elderly patients
 全文:
摘要：

探讨研究围术期保温对老年患者的止血功能的影响。方法 选择60例腹腔镜下行直肠癌根治术老年患者，ASAⅠ~Ⅱ级，完全随机分为两组，每组30例，Ⅰ组为对照组，按常规手术进行；Ⅱ组为试验组，采用综合性保温。分别监测和记录两组患者在麻醉前及麻醉后30、60、90、120 min和术毕的鼻咽温度。麻醉前，术中30、60、90、120 min和术毕，术后24、48、72、120 h取外周静脉血测量两组老年患者凝血酶原时间(prothrombin time，PT)、活化部分凝血活酶时间(activated partialthromboplastin time，APTT)、凝血酶时间(thrombin time，TT)、血小板计数(platelets，PLT)、D-二聚体(D-dimer，DD)、纤维蛋白原(fibrinogen，FBG)和血管性血友病因子(von willebrand factor，vWF)的含量。结果 Ⅰ组麻醉后30、60、90、120 min及术毕时体温(℃)[分别为(36.52±0.08)，(36.22±0.07)，(35.83±0.07)，(35.68±0.06)和(35.65±0.06)]较麻醉前(36.86±0.08)和Ⅱ组同时间体温(℃)[分别为(36.83±0.12)，(36.80±0.10)，(36.78±0.11)，(36.76±0.10)和(36.80±0.11)]明显降低(P<0.05)。Ⅰ组在术中30、60、90、120 min和术毕时的PT(s)[分别为(16.12±0.31)，(16.32±0.51)，(16.21±0.33)，(16.32±0.42)和(16.32±0.32)]、APTT(s) [(39.33±3.32)，(39.22±3.21)，(42.23±3.12)，(43.42±3.23)和(44.42±3.32)]、TT(s)[(16.2±1.0)，(16.3±1.1)，(17.1±1.4)，(17.3±1.4)和(18.3±1.4)]较麻醉前的PT(14.12±0.21) s、APTT(34.32±1.54) s和TT(14.1±0.5) s以及Ⅱ组同时间的PT(s)[分别为(13.32±0.23)，(13.42±0.21)，(13.32±0.22)，(13.42±0.31)，(14.21±0.12)]、APTT(s)[分别为(35.32±1.42)，(35.23±1.34)，(34.21±1.44)，(34.21±1.42)，(34.12±1.33)]和TT(s)[分别为(14.0±0.4)，(14.4±0.3)，(14.2±0.4)，(14.2±0.5)，(14.0±0.4)]明显延长(P<0.05)；Ⅰ组在术中120 min，术毕和术后24、48、72 h时的PLT含量(×109/L)[分别为(178±13)，(121±15)，(131±34)，(123±35)，(166±14)]较麻醉前(213±12)×109/L和Ⅱ组同时间的PLT含量(×109/L)[分别为(209±14)，(192±13)，(198±17)，(203±18)，(216±15)]明显降低(P<0.05)；Ⅰ组在术后24、48、72 h的DD含量(mg/L) [分别为(1.01±0.11)，(0.82±0.13)，(0.71±0.12)]和vWF的含量(%)[分别为(220±23)，(183±20)，(126±18)]较麻醉前DD含量(0.41±0.12) mg/L和vWF含量(92±12) %以及Ⅱ组同时间DD含量(mg/L) [分别为(0.44±0.12)，(0.45±0.22)，(0.45±0.21)]和vWF含量(%)[分别为(94±12)，(96±13)，(95±11)]明显升高(P<0.01)，同时间Ⅰ组FBG的含量(%)[分别为(1.5±0.3)，(1.6±0.3)，(2.1±0.3)]也较麻醉前(2.5±0.3) %和Ⅱ组(%)[分别为(2.5±0.4)，(2.5±0.4)，(2.5±0.5)]明显降低(P<0.05)。结论 围术期综合性保温能够部分减轻老年患者术后止血功能抑制程度，使患者早期康复。
关键词： 围术期；保温；老年患者；止血功能
Abstract:

Objective To research the effect of perioperative thermal preservation on hemostatic function in elderly patients. Methods 60 elderly patients undergone the radical laparoscopic rectal cancer resection, with ASAⅠ-Ⅱ, were randomly divided into two groups, each group was thirty patients. Control group(groupⅠ) was routine operation, experimental group (groupⅡ) was comprehensively heat preservation. To monitor and record respectively the nose pharynx temperature of each group patients in pre-anesthesia, 30, 60, 90, 120 min post-anesthesia and after operations. To abstract peripheral blood from the elderly patients and measure prothrombin time(PT), activated partialthromboplastin time(APTT), thrombin time(TT), platelets (PLT), D-dimer(DD), fibrinogen(FBG), von willebrand factor(vWF) levels in pro-anesthesia, 30, 60, 90, 120 min intraoperations, post-operation, and 24, 48, 72, 120 h post-operation. Results The temperature in groupⅠ(℃)[(36.52±0.08), (36.22±0.07), (35.83±0.07), (35.68±0.06) and (35.65±0.06)] was lower than that in pro-anesthesia (36.86±0.08) ℃ and that in the same time in groupⅡ(℃)[(36.83±0.12), (36.80±0.10), (36.78±0.11), (36.76±0.10) and (36.80±0.11)] in 30, 60, 90, 120 min post-anesthesia and post-operations(P<0.05). The levels of PT(s)[ (16.12±0.31), (16.32±0.51), (16.21±0.33), (16.32±0.42) and (16.32±0.32)], APTT(s)[(39.33±3.32), (39.22±3.21), (42.23±3.12), (43.42±3.23) and (44.42±3.32)] and TT(s)[(16.2±1.0), (16.3±1.1), (17.1±1.4), (17.3±1.4) and (18.3±1.4)] in groupⅠwere significantly longer than that PT(14.12±0.21) s, APTT(34.32±1.54) s and TT(14.1±0.5) s in pre-anesthesia and that PT(s)[(13.32±0.23), (13.42±0.21), (13.32±0.22), (13.42±0.31), (14.21±0.12)], APTT(s)[(35.32±1.42), (35.23±1.34), (34.21±1.44), (34.21±1.42), (34.12±1.33)] and TT(s)[(14.0±0.4), (14.4±0.3), (14.2±0.4), (14.2±0.5), (14.0±0.4)] in the same time in groupⅡin 30, 60, 90, 120 min intraoperations and post-operations (P<0.05). The levels of PLT(×109/L)[(178±13)，(121±15)，(131±34)，(123±35)，(166±14)] in groupⅠwere obviously lower than that in pro-anesthesia (213±12)×109/L and that PLT(×109/L)[(209±14), (192±13), (198±17), (203±18), (216±15)] in the same time in groupⅡin 120 min intraoperations, post-operations and 24, 48, 72 h post-operations(P<0.05). The levels of DD(mg/L)[(1.01±0.11), (0.82±0.13), (0.71±0.12)] and vWF(%)[(220±23), (183±20), (126±18)] were markedly higher than that DD (0.41±0.12) mg/L and vWF (92±12)% in pro-anesthesia and that DD(mg/L)[(0.44±0.12), (0.45±0.22), (0.45±0.21)] and vWF(%)[(94±12), (96±13), (95±11)] in the same time in groupⅡ in 24, 48, 72 h post-operation (P<0.01), but the levels of FBG(%)[(1.5±0.3), (1.6±0.3), (2.1±0.3)]were distinctly lower than that FBG (2.5±0.3)% in pro-anesthesia and groupⅡ(%)[(2.5±0.4), (2.5±0.4), (2.5±0.5)] in the same time(P<0.05). Conclusions The perioperative comprehensive heat preservation can partly alleviate hemostatic function suppression in elderly patients after operations and make them early recovery.
Key words: Perioperative；Thermal preservation；Elderly patient；Hemostatic function