张琦+薛久巍+柴方圆++崔洋

[摘要]目的 采用血栓彈力图（TEG）评价蛛网膜下腔阻滞麻醉剖宫产中对产妇凝血功能的影响，评价麻醉、手术利弊，总结凝血功能管理经验。方法 2015年2月～2016年2月，选取牡丹江医学院第二附属医院产科行计划性剖宫产采用蛛网膜下腔阻滞麻醉手术产妇700例，分别在麻醉前、麻醉1 h采上下肢静脉血进行TEG检测，进行对比。结果 完成研究674例。麻醉前，上肢R高于下肢，上肢A、CI低于下肢，差异有统计学意义（P<0.05）。麻醉1 h后，上肢K低于下肢，上肢MA、CI高于下肢，差异有统计学意义（P<0.05）。麻醉1 h后，上肢R、K低于麻醉前，上肢A、MA、CI高于麻醉前，下肢MA低于麻醉前，差异有统计学意义（P<0.05）。结论 妊娠会导致上下肢凝血状态差异；麻醉与手术会影响上下肢凝血状态，对上肢影响更显著。

[关键词]剖宫产；蛛网膜下腔阻滞麻醉；凝血功能；血栓弹力图

[中图分类号] R719.8 [文献标识码] A [文章编号] 1674-4721（2017）04（b）-0128-03

Analysis of the effect of TEG on the blood coagulation function in puerpera undergoing cesarean section with subarachnoid anesthesia

ZHANG Qi1 XUE Jiu-wei2▲ CAI Fang-yuan1 CUI Yang1

1.Department of Anaesthesia，the Second Affiliated Hospital of Mudanjiang Medical University in Heilongjiang Province，Mudanjiang 157000，China；2.Department of Blood Specialty， the Second Affiliated Hospital of Mudanjiang Medical University in Heilongjiang Province，Mudanjiang 157000，China

[Abstract]Objective To evaluate the effect of TEG on the blood coagulation function in puerpera undergoing cesarean section with subarachnoid anesthesia，and to evaluate the advantages and disadvantages of anesthesia and operation，and to summarize the coagulation function management experience.Methods From February 2015 to February 2016，700 puerperae schedule for cesarean section with subarachnoid anesthesia in Department of Obstetrics of the Second Affiliated Hospital of Mudanjiang Medical University were selected.TEG detection was conducted with venous blood upper and lower limbs to compare before anesthesia and after 1 h of anesthesia.Results 674 patients completed the study.Before anesthesia，R of the upper limbs was higher than that of lower limbs，A，CI of upper limbs was lower than those of the lower limbs，and the difference was statistically significant （P<0.05）.After 1 h of anesthesia，K of the upper limbs was lower than that of upper limbs，A，MA，CI of upper limbs was higher than of lower limbs，and the difference was statistically significant （P<0.05）.After 1 h of anesthesia，R，K of upper limbs was lower than before anesthesia，the upper limb A，MA，CI was higher than that before anesthesia，MA of the lower limbs than before anesthesia，the difference was statistically significant （P< 0.05）.Conclusion Pregnancy can cause the change of blood coagulation of upper limbs and lower limbs，anesthesia and operation will affect the blood coagulation of the upper and lower limbs，and the upper limb is more significant.

[Key words]Cesarean section；Subarachnoid block anesthesia；Blood coagulation function； Thrombelastogram

剖宫产是处理高危妊娠的一种术式，我国剖宫产术执行率最高的国家之一，平均执行率在30%左右，城市执行率较高[1]。蛛网膜下腔阻滞麻醉是剖宫产术麻醉的重要方法，既往针对该麻醉利弊的研究主要集中在麻醉效果、不良反應方面[2-3]。凝血功能管理是围生期管理的重要内容之一，产妇因妊娠等原因，往往处于高凝状态，易出现下肢静脉血栓形成等并发症，同时因分娩，又容易出现产后出现出血，分析麻醉对产妇凝血功能的影响非常必要[4]。血栓弹力图（thrombe？鄄lastogram，TEG）是检测抗血小板功能的重要方法，主要用于抗血小板治疗、血小板抵抗评估。本研究试采用TEG评价蛛网膜下腔阻滞麻醉剖宫产中对产妇凝血功能的影响，现报道如下。

1资料与方法

1.1一般资料

以2015年2月～2016年2月在医院产科行计划性剖宫产产妇作为研究对象。纳入标准：①计划性剖宫产，非急诊；②未合并原发性凝血功能障碍，或严重子痫等病理性原因所致凝血功能变化；……