Effects of epidural block on coagulation and hemorheology indicators in patients undergoing gynecological laparoscopic surgery / 中国基层医药

ABSTRACT

Objective To learn the effects of epidural block on coagulation and hemorheology indicators in patients undergoing gynecological laparoscopic surgery .Methods 166 patients undergoing gynecological laparoscopic surgery were randomly divided into control group (n=77) and observation group(n=89) by the random number table method.The anesthesia induction and anesthesia maintenance methods were the same in the two groups ,while the observation group was given epidural block analgesia .The operation time ,intraoperative blood loss and intraoperative transfusion volume were compared between the two groups ,and visual analogue scale ( VAS) was used to evaluate the degree of postoperative pain.Before anesthesia,15min after pneumoperitoneum,30min after pneumoperitoneum, 30min after pneumoperitoneum stopped ,24h after operation and 48h after operation were set up as T 0 ,T1 ,T2 ,T3 ,T4 and T5.The prothrombin time(PT),fibrinogen(Fib),activated partial thromboplastin time (APTT),two D-dimer content(D -D) were observed.And hemorheological indicators,including plasma viscosity,blood viscosity(low shear,medium shear,high shear),red blood cell aggregation were observed .Results There were no statistically significant differences between the two groups in the operation time , intraoperative blood loss and the amount of intraoperative infusion(t=0.638,1.571,1.601,all P>0.05).The VAS score of the observation group [(1.8 ± 0.6)points]was lower than that of the control group (t=17.444,P<0.05).At T1,T2,T3 and T4,APTT of the control group were lower than those at T 0 ,APTT of the control group were lower than that of the observation group ( all P<0.05).At T1,T2,T3,T4 and T5,Fib and D-D of the two groups were higher than those at T 0,Fib and D-D of the control group were higher than those of the observation group (t=3.003,5.056,4.695,6.173,2.539,3.473,3.041, 8.831,2.612,10.746,all P<0.05).At T1,plasma viscosity,low shear blood viscosity,middle shear blood viscosity, high shear blood viscosity and erythrocyte aggregation of the observation group were (1.28 ±0.18) mPa/s,(9.53 ± 0.79)mPa/s,(6.09 ±0.89) mPa/s,(4.31 ±0.75) mPa/s,(1.41 ±0.21),respectively,which were lower than those at T0(t=2.805,4.148,4.276,4.497,6.804,all P<0.05).At T2,T3,T4 and T5,plasma viscosity,low shear blood viscosity ,blood viscosity ,blood high cut viscosity ,erythrocyte aggregation of the control group were higher than those at T0 (all P <0.05).At T1,T2,T3,T4,T5,plasma viscosity,low shear viscosity of blood,cutting blood viscosity,high shear blood viscosity and erythrocyte aggregation of the observation group were lower than those of control group(all P<0.05).Conclusion Epidural blockade can improve the coagulation function and hemorheology indicators of patients undergoing gynecological laparoscopic surgery ,it has good clinical application value .