de la Fuente Tornero E, Garutti Martínez I, Gutiérrez Tonal B, Rodríguez Huertas A, Chana Rodríguez F, Villanueva Martínez M, Pascual Izquierdo C
Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid.
Rev Esp Anestesiol Reanim. 2010 Jun-Jul;57(6):333-40. doi: 10.1016/s0034-9356(10)70245-0.
Surgery promotes a state of hypercoagulability, predisposing to the possibility of postoperative thromboembolic complications. Our aim was to determine whether certain combinations of techniques (neuraxial, intravenous or both) for anesthesia and analgesia might be associated with attenuation of the prethrombotic state following total hip or knee replacement.
Prospective longitudinal study of 45 patients undergoing elective hip or knee prosthetic surgery. The patients were randomized to 3 groups to receive different anesthesia-analgesia combinations: spinal-intravenous, spinal-epidural, or general-intravenous. From induction until 36 hours after surgery, we recorded the postoperative time course of the following markers of coagulation and fibrinolysis: platelet count; fibrinogen level; activated partial thromboplastin time; international normalized ratio; and levels of prothrombin activation fragments 1 and 2, thrombin-antithrombin III complex, and D-dimer.
No statistically significant between-group differences were found in patient demographic, clinical, surgical or postoperative data. No symptomatic thromboembolic complications or deaths were recorded in the 30 days after surgery. Statistically significant differences were found in laboratory results for samples taken 36 hours after surgery. Patients who received spinal-epidural anesthesia and analgesia had lower levels of prothrombin activation fragments 1 and 2 and longer activated partial thromboplastin times than the group receiving the spinal-intravenous combination.
The anesthetic technique used during surgery did not affect hemostasis. However, continuous epidural analgesia in the postoperative recovery period attenuated some markers of hypercoagulability.
手术会引发高凝状态，增加术后血栓栓塞并发症的发生可能性。我们的目的是确定全髋关节或膝关节置换术后，某些麻醉和镇痛技术组合（神经轴索、静脉或两者皆用）是否可能与血栓前状态的减轻有关。
对45例行择期髋关节或膝关节置换手术的患者进行前瞻性纵向研究。将患者随机分为3组，接受不同的麻醉 - 镇痛组合：脊髓 - 静脉、脊髓 - 硬膜外或全身 - 静脉。从诱导期至术后36小时，我们记录了以下凝血和纤溶标志物的术后时间进程：血小板计数；纤维蛋白原水平；活化部分凝血活酶时间；国际标准化比值；以及凝血酶原激活片段1和2、凝血酶 - 抗凝血酶III复合物和D - 二聚体的水平。
患者的人口统计学、临床、手术或术后数据在组间未发现统计学上的显著差异。术后30天内未记录到有症状的血栓栓塞并发症或死亡病例。术后36小时采集的样本的实验室结果存在统计学上的显著差异。接受脊髓 - 硬膜外麻醉和镇痛的患者，其凝血酶原激活片段1和2的水平低于接受脊髓 - 静脉组合的组，且活化部分凝血活酶时间更长。
手术期间使用的麻醉技术不影响止血。然而，术后恢复期的持续硬膜外镇痛减轻了一些高凝状态的标志物。
