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-four ASAâ… orâ…¡old patients undergoing selective abdominal surgeries were divided randomly into three groups:group A(receive general anesthesia combined with continuous epidural anesthesia,n=8);group B(receive general anesthesia,n=8);group C(receive continuous epidural anesthesia,n=8).In group B,patients were finished with convention followed by patient-controlled intravenous analgesia(PCIA);while in group A and group C,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 same time as when lacerating skins for group C),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:the level of vWF of group B was higher than group A and C at T2;group B was higher than group C at T3,while there were no significant differences between group A and C.There were no significant differences between the four time points for every group.2) FIB:the level of FIB of group A at T4 was higher than that at T1,T2 and T3;the level of FIB of group C at T4 was higher than that at T2 and T3.3) D-Dimer: the level of D-Dimer of group B at T2 was higher than group A.For group A,the level of FIB at T4 was higher than that at T1,T2,and T3.For group B,the level of FIB at T2 was higher than that at T1,T3,and T4. 4)TAT:the differences between three groups at four time points and the differences between four time points for every group were not significant. 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.