Davis F M, McDermott E, Hickton C, Wells E, Heaton D C, Laurenson V G, Gillespie W J, Foate J
Br J Anaesth. 1987 May;59(5):561-71. doi: 10.1093/bja/59.5.561.
One hundred and one patients with osteoarthritis were randomly allocated to undergo total hip arthroplasty under either spinal (subarachnoid) or general anaesthesia. Venous blood was sampled before, during and after surgery and on the 5th day after operation to study the haemostatic mechanism. There were no preoperative differences between the two anaesthetic groups. Although there was pronounced individual variability, similar patterns of change in coagulation, platelets and fibrinolysis were seen in both groups. However, there were significant differences between the two groups in platelet count, thrombin production, and Factor VIIIRAg in the intra- and immediate postoperative periods. Also, compared with general anaesthesia, there was less intraoperative activation of fibrinolysis, as measured by the euglobulin clot lysis time, with spinal anaesthesia. These differences suggest slight modification of the haemostatic response to surgery with spinal anaesthesia, which could be consistent with a neuroendocrine mechanism. By the 5th day both groups exhibited a very similar "hypercoagulable" postoperative state.
101例骨关节炎患者被随机分配接受脊髓（蛛网膜下腔）麻醉或全身麻醉下的全髋关节置换术。在手术前、手术期间和手术后以及术后第5天采集静脉血样，以研究止血机制。两个麻醉组术前无差异。尽管存在明显的个体差异，但两组的凝血、血小板和纤维蛋白溶解变化模式相似。然而，两组在术中和术后即刻的血小板计数、凝血酶生成和因子VIIIRAg方面存在显著差异。此外，与全身麻醉相比，脊髓麻醉时通过优球蛋白凝块溶解时间测量的术中纤维蛋白溶解激活较少。这些差异表明脊髓麻醉对手术止血反应有轻微改变，这可能与神经内分泌机制一致。到第5天，两组均表现出非常相似的术后“高凝”状态。
