Kang Jiaxiang, Lin Wenxiang, Wang Han, Liang Yijie, Yu Zhenxing
Department of Orthopedics, Zhangzhou Affiliated Hospital of Fujian Medical University Zhangzhou 363000, Fujian Province, China.
Am J Transl Res. 2022 Jul 15;14(7):4786-4794. eCollection 2022.
To explore the effects of general anesthesia and epidural anesthesia on deep vein thrombosis (DVT) and perioperative cognitive function of patients undergoing total knee arthroplasty.
A retrospective analysis was conducted on 110 orthopedic patients who underwent total knee arthroplasty at Zhangzhou Affiliated Hospital of Fujian Medical University from March 2018 to March 2021. According to different anesthesia schemes, 56 cases with epidural anesthesia were included in the observation group and 54 patients with general anesthesia were assigned to the control group. The following items were recorded and compared between the two groups: postoperative coagulation indicators; operation duration, total dosage of anesthetics; postoperative recovery time; heart rate (HR) and mean arterial pressure (MAP) before anesthesia induction (T0), intubation (T1), and completion of the operation (T2); cognitive function before surgery and 1 d and 3 d after surgery; postoperative incidence of DVT; pain at postoperative 24 h; stress-related factors before and 2 h after surgery, and incidence of adverse reactions during hospitalization.
Compared to the control group, the levels of fibrinogen (Fbg) and platelets (PLC) in the observation group 24 hours after surgery were significantly lower, with longer thrombin time (TT) and prothrombin time (PT) (all P<0.05); no significant difference was found in operation duration between the two groups (P>0.05). Total dosage of anesthetics and postoperative recovery time were less in the observation group (P<0.05); the HR and MAP fluctuations were lower in the observation group (P<0.05). The postoperative cognitive function score of patients in the observation group was significantly higher (P<0.05), with a lower incidence of postoperative DVT (P<0.05) and better relief of pain (P<0.05). The expression levels of stress-related factors 2 h after surgery and the incidence of adverse reactions were lower in the observation group compared to the control group (P<0.05).
In total knee arthroplasty, epidural anesthesia, compared with general anesthesia, can reduce the incidence of DVT in patients and has less impact on patients' cognitive function and stress state with a higher safety profile.
探讨全身麻醉与硬膜外麻醉对全膝关节置换术患者深静脉血栓形成（DVT）及围手术期认知功能的影响。
回顾性分析2018年3月至2021年3月在福建医科大学附属漳州医院行全膝关节置换术的110例骨科患者。根据不同麻醉方案，将56例行硬膜外麻醉的患者纳入观察组，54例行全身麻醉的患者分配至对照组。记录并比较两组以下各项指标：术后凝血指标；手术时长、麻醉药总用量；术后恢复时间；麻醉诱导前（T0）、插管时（T1）及手术结束时（T2）的心率（HR）和平均动脉压（MAP）；术前及术后1 d、3 d的认知功能；术后DVT发生率；术后24 h疼痛情况；术前及术后2 h应激相关因子，以及住院期间不良反应发生率。
与对照组相比，观察组术后24小时纤维蛋白原（Fbg）和血小板（PLC）水平显著降低，凝血酶时间（TT）和凝血酶原时间（PT）延长（均P<0.05）；两组手术时长差异无统计学意义（P>0.05）。观察组麻醉药总用量及术后恢复时间较少（P<0.05）；观察组HR和MAP波动较小（P<0.05）。观察组患者术后认知功能评分显著更高（P<0.05），术后DVT发生率更低（P<0.05），疼痛缓解更好（P<0.05）。与对照组相比，观察组术后2 h应激相关因子表达水平及不良反应发生率更低（P<0.05）。
在全膝关节置换术中，与全身麻醉相比，硬膜外麻醉可降低患者DVT发生率，对患者认知功能和应激状态影响较小，安全性更高。
