Smyth R, Cheng D, Asokumar B, Chung F
Department of Anaesthesia, Toronto Hospital, University of Toronto, Ontario, Canada.
Anesth Analg. 1995 Oct;81(4):680-5. doi: 10.1097/00000539-199510000-00004.
This prospective, randomized study evaluated the effects of spinal versus general anesthetic technique on perioperative blood loss and the development of postoperative coagulopathies in 50 patients undergoing transurethral resection of the prostate (TURP). Preoperative hematologic measurements included hemoglobin, platelet count, electrolytes, prothrombin time, partial thromboplastin time, fibrinogen, factor V, plasminogen, antithrombin III, and fibrinogen degradation product (FDP) levels. All hematologic blood samples wre repeated postoperatively at 1, 6, and 24 h. Intraoperative blood loss was not significantly different between the spinal and general anesthesia groups. The total blood loss after TURP was significantly correlated (r = 0.76; P < 0.0001) with the prostatic tissue weight. When the tissue weight resected exceeded 35 g, blood loss was in excess of the linear correlation shown with the weight of resected prostatic tissue. Platelet count decreased and prothrombin time increased in the spinal group at all postoperative time intervals compared to preoperative value (P < 0.05). There was no significant difference in measured coagulation variables (fibrinogen, factor V, plasminogen, antithrombin III, and FDP) between the spinal and general anesthesia groups, but there were significant decreases in postoperative fibrinogen and Factor V levels compared to preoperative values in both spinal and general anesthesia groups. Three patients (6%) had increased FDP levels 1 h postoperatively. The prostatic tissue weight and the surgical duration was significantly higher in these patients. We conclude that perioperative blood loss in TURP patients is not affected by the anesthetic technique. However, 6% of TURP patients developed subclinical intravascular coagulopathies which correlated with mass of resected prostate tissue.
这项前瞻性随机研究评估了脊髓麻醉与全身麻醉技术对50例接受经尿道前列腺切除术（TURP）患者围手术期失血及术后凝血病发生情况的影响。术前血液学检测指标包括血红蛋白、血小板计数、电解质、凝血酶原时间、部分凝血活酶时间、纤维蛋白原、因子V、纤溶酶原、抗凝血酶III和纤维蛋白原降解产物（FDP）水平。所有血液学样本均在术后1小时、6小时和24小时重复采集。脊髓麻醉组和全身麻醉组术中失血量无显著差异。TURP术后总失血量与前列腺组织重量显著相关（r = 0.76；P < 0.0001）。当切除的组织重量超过35克时，失血量超过与切除前列腺组织重量的线性相关性。与术前值相比，脊髓麻醉组在所有术后时间间隔血小板计数均下降，凝血酶原时间均延长（P < 0.05）。脊髓麻醉组和全身麻醉组在测量的凝血变量（纤维蛋白原、因子V、纤溶酶原、抗凝血酶III和FDP）方面无显著差异，但与术前值相比，脊髓麻醉组和全身麻醉组术后纤维蛋白原和因子V水平均显著下降。3例患者（6%）术后1小时FDP水平升高。这些患者的前列腺组织重量和手术时间显著更长。我们得出结论，TURP患者围手术期失血不受麻醉技术影响。然而，6%的TURP患者发生了亚临床血管内凝血病，这与切除的前列腺组织量相关。
