以血栓彈力圖評估不同的麻醉方式在關節鏡手術上對於止血功能的影響

The Effect of Anesthetic Techniques on Hemostatic Function in Arthroscopic Surgery: Evaluation by Thromboelastography

背景：已知不同的麻醉方式可能會影響止血功能，且可能因此而導致手術後靜脈栓塞的形成。本實驗利用血栓彈力圖來評估全身與半身麻醉對於止血功能的影響。方法：本實驗選取四十個接受膝關節鏡手術的正常健康年輕男性病人，將其以雙盲隨機取樣的方式分為兩組，每組二十個病人。分別於四個時間點抽血測量血栓彈力圖、prothrombin time、activated partial-thromboplastin time以及血小板數目。第一個時間點為手術前；第二個時間點為麻醉後，劃刀前；第三個時間點為劃刀後三十分鐘；第四個時間點為手術完成後三個小時。結果：全身與半身麻醉不論在同組或不同組之間做比較，結果顯示四個時間點的止血功能皆無明顯的差異性。結論：在本實驗中，我們並未發現不同的麻醉方式會影響止血功能。

Background: Anesthetic techniques are known to affect blood hemostasis, which may be responsible for the pathogenesis of postoperative venous thromboembolism. The purpose of this study was to evaluate the effect of general and spinal anesthesias on blood hemostasis using thromboelastography. Methods: Forty patients undergoing arthroscopic knee surgery were enrolled for study and randomly allocated to one of two groups, to receive either general (GA; n = 20) or spinal anesthesia (SA; n = 20). In addition to thromboelastography, prothrombin and activated partial-thromboplastin time, and haematocrit and platelet count were also examined concurrently. Blood was sampled and examined before anesthesia to provide the baseline data (Time 1). Three more evaluations were performed at different time, i.e., twenty minutes after induction of anesthesia and just prior to skin incision (Time 2), thirty minutes after skin incision (Time 3), and three hours after surgery (Time 4). Results: There were no intra-or inter-group differences noted as comparing the measured parameters obtained prior to, during, or three hours after surgery. Conclusions: From the present study, we do not find any individual anesthetic technique which would have effect on the hemostasis of patients who received diagnostic arthroscopic surgery.