Liu Dongzhi, Sun Chengliang, Zhang Xiuli, Zhao Zhibin
Department of Anesthesiology, The First People's Hospital of Lianyungang, The Affiliated Lianyungang Hospital of Xuzhou Medical University, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang Clinical College of Nanjing Medical University Lianyungang 222000, Jiangsu Province, China.
Am J Transl Res. 2021 Sep 15;13(9):10933-10941. eCollection 2021.
This study aimed to explore the application value of epidural and general anesthesia in total knee arthroplasty (TKA).
We first retrospectively analyzed 156 patients who underwent total knee arthroplasty in our hospital from January 2019 to January 2020 as subjects. The control group (CG) included 86 subject who were treated with general anesthesia. The remaining 70 subjects with epidural anesthesia were divided to a research group (RG). The recovery and adverse reactions after surgery were compared. The coagulation function before and after surgery was analyzed. The incidence of deep vein thrombosis (DVT) after surgery was observed. The expression of inflammatory factors and the improvement of cognitive function were assessed before surgery, followed by 6 and 12 h after surgery. The pain degree of patients was compared at 6 and 12 h after surgery.
Compared with the CG, the recovery condition after surgery in the RG were dramatically lower, the concentrations of PLT, PT, and APTT in the RG were higher, while FBG was markedly lower. The incidence of postoperative venous thrombosis in the RG was lower. The TNF-α, IL-6 levels, and VAS scores in the RG were remarkably lower at 6 and 12 h after surgery. MMSE score was significantly higher than CG score. The total incidence of adverse reactions in the RG was markedly lower.
Epidural anesthesia can improve blood coagulation and cognitive function in patients undergoing TKA and reduce the incidence of DVT and the degree of postoperative pain.
本研究旨在探讨硬膜外麻醉和全身麻醉在全膝关节置换术（TKA）中的应用价值。
我们首先回顾性分析了2019年1月至2020年1月在我院接受全膝关节置换术的156例患者作为研究对象。对照组（CG）包括86例接受全身麻醉的患者。其余70例接受硬膜外麻醉的患者分为研究组（RG）。比较两组术后的恢复情况和不良反应。分析手术前后的凝血功能。观察术后深静脉血栓形成（DVT）的发生率。评估手术前、术后6小时和12小时炎症因子的表达及认知功能的改善情况。比较术后6小时和12小时患者的疼痛程度。
与CG组相比，RG组术后恢复情况明显更好，RG组血小板（PLT）、凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）浓度更高，而纤维蛋白原（FBG）明显更低。RG组术后静脉血栓形成的发生率更低。RG组术后6小时和12小时肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）水平及视觉模拟评分（VAS）明显更低。简易精神状态检查表（MMSE）评分明显高于CG组。RG组不良反应总发生率明显更低。
硬膜外麻醉可改善TKA患者的凝血功能和认知功能，降低DVT发生率及术后疼痛程度。
