The Influence Of High Risk Factors Of Perioperative Stroke In Old Patients Under Different Anesthesia Techniques

Objective: To observe the change of PTS markers in old patients after abdominal operations; to compare the difference of PTS markers under different anesthesia techniques after abdominal operations in old patients, and thereby prognose its influence of perioperative stroke in old patients.Methods: It's a prospective randomized control study. Twenty-one ASA I or II old patients undergoing elective abdominal surgeries were divided randomly into two groups: group A (receive general anesthesia, n=10); group B(receive general anesthesia combined with continuous epidural anesthesia, n=ll). In group A, patients were finished with convention followed by patient-controlled intravenous analgesia (PCIA); while in group B, patients were given 0.375% bupivacaine to maintain the block level, and were finished by patient-controlled epidural analgesia (PCEA). Blood samples were taken at pre-anesthesia (T₁),the end of induction (T₂),the end of operation (T₃) and postoperative 72 h(T₄) to determine activation variables of platelet (vWF),coagulation variables (FIB),anticoagulation variables(TAT) and fibrinolysis variables(D-Dimer).Results: (1)vWF: vWF levels in group A were not changed throughout the procedure, but obviously decreased in group B at T₃ compared with baseline and those in group A; (2) FIB: the FIB levels in both group A and group B obviously elevated postoperatively, but the FIB levels in group B were lower than those in group A at T₂; (3)D-Dimer: the D-Dimer levels in both group A and group B obviously increased and peaked at T₃, and there were no significant difference between group A and group B at each point; (4)TAT: the TAT levels in group A were obviously increased at T₂, peaked at T₃, and then returned to the baseline at T₄, and became higher than those in group B; while those in group B were not changed greatly throughout the procedure.Conclusions: Compared with general anesthesia , anesthesia combined with continuous epidural anesthesia decreases the activity of platelet caused by injury of endothelium, decreases the postoperative hypercoagulation in old patients after abdominal operations; however , it is not helpful in improving th fibrinolytic function. On the whole, general anesthesia combined with continuous epidural anesthesia has benefit in the banlance of coagulation and anticoagulation, so it can prevent the perioperative stroke in old patients.