【摘要】 目的:观察术后疼痛应激与术后硬膜外镇痛对术后病人血小板活化及血凝状态的影响。方法:40例择期腹部手术患者(ASAⅡ~Ⅲ级,年龄45~68岁),随机分为硬膜外镇痛组(E组)和对照组(C组),每组20例。E组采用全麻联合硬膜外阻滞+术后硬膜外镇痛,C组采用全麻+术后间断肌注哌替啶镇痛。分别于术后8、24、36、48、60、72h用视觉模拟评分法(VAS)评定疼痛程度;于术前及术后1、2、3、4、5d抽取外周静脉血用来测定血小板表面膜糖蛋白CD41/CD61、CD62p及CD63的表达量,血小板聚集率,凝血酶原时间(PT)、凝血酶时间(TT)及活化部分凝血活酶时间(APTT)。结果:E组术后镇痛效果良好,术后8、24、36、48h的VAS评分显著低于C组(P<0.05,P<0.01)。与术前比较,两组术后第1天的血小板表面膜糖蛋白CD41/CD61、CD62p和CD63的表达量及血小板聚集率均有明显升高(P<0.05,P<0.01);与E组比较,C组术后1~4d血小板表面膜糖蛋白CD41/CD61、CD62p及CD63的表达量及血小板聚集率明显增加,两组之间差异显著(P<0.05,P<0.01)。术后第2、3天,C组PT、TT和APTT均有明显缩短,与术前比较有显著性差异,与E组比较其差异也有显著性意义(P<0.05)。结论:术后病人的高血凝状态与血小板活化程度增高有一定关系。术后疼痛应激可促进血小板活化及血小板聚集,缩短凝血时间,使机体处于相对高血凝状态;良好的术后镇痛有利于抑制机体的有害应激反应,降低血小板活性,改善术后患者的高血凝状态,可作为减少术后血栓性并发症、提高手术病人康复质量的有效措施之一。更多还原

【Abstract】 Objective To observe the effects of postoperative pain stress and postoperative epidural analgesia on the platelet activation and coagulation status of postoperative patients. Methods 40 ASA Ⅱ-Ⅲ patients aged from 45 to 68 years old undergoing elective abdominal surgery were randomly divided into epidural analgesia group (group E, n = 20) and control group (group C, n = 20). The patients in group E received the combined anesthesia of general anesthesia and epidural block plus postoperative epidural analgesia, and the patients in group C received general anesthesia plus postoperative intramuscular pethidine analgesia intermittently. VAS was used to assess pain intensity at the points of 8、24、36、48、60、72 h after surgery; blood samples were taken from peripheral vein before operation and on the 1st, 2nd, 3rd, 4th and 5th postoperative days for determination of the expression of CD41/CD61、CD62p and CD63 of the glycoproteins on the platelet membrane surface, the platelet aggregation rate and PT、 TT and APTT. Results The patients in group E achieved good postoperative analgesic results, VAS at 8、24、36、48 h after the operation in group E were markedly lower than that in group C (P < 0.05, P < 0.01). Compared with the basic value before operation, the expression of CD41/CD61、CD62p、 CD63 and platelet aggregation rate in the two groups were significantly increased on the 1st postoperative day (P < 0.05, P < 0.01); the expression of CD41/CD61、CD62p、 CD63 and platelet aggregation rate in group C were all obviously higher than those in group E during the four postoperative days (P < 0.05, P < 0.01). PT、TT and APTT in group C all shortened on the 2nd and 3rd postoperative days, and there were distinct differences compared with the basic value before operation and the values in group E (P < 0.05). Conclusion The postoperative patient’s hypercoagulable status is to a certain degree related to the increase of platelet activity. Postoperative pain stress can promote platelet activation and platelet aggregation, shorten coagulation time, and put the patient in a relative hypercoagulable status. A good postoperative analgesia can help to inhibit the vicious stress response of the body, lower the platelet activity and ameliorate the hypercoagulable status, and therefore can act as one effective way to reduce the chances of postoperative thrombus complication and improve the patient’s rehabilitation.更多还原