Effect Of Thoracic Epidural Analgesia On Coagulation And Fibrinolysis Dynamic Balance In Patients Undergoing Major Thoracic Surgery

PART ONE:EFFECT OF THORACIC EPIDURAL ANALGESIA ON COAGULATION AND FIBRINOLYSIS DYNAMIC BALANCE IN PATIENTS UNDERGOING MAJOR THORACIC SURGERYObjective: To evaluate the effect of thoracic epidural analgesia(TEA) on coagulation and fibrinolysis dynamic balance in patients undergoing thoracic surgery in perioperative period by means of coagulation and fibrinolysis dynamic-pattern (CF).Methods: Forty patients undergoing thoracotomy (esophageal cancer radical correction and lobectomia pulmonalis) were randomized to receive either combined general-epidural anesthesia (GEA group, n=20) or general anesthesia (GA group, n=20). The fasting antebrachial venous blood of patients were drawn before anesthesia (basic value), at closing chest and on the 1st and 3rd day after operation respectively to measure Platelet (PLT), Fibrinogen (FIB) and make coagulation and fibrinolysis dynamic-pattern, and deep venous color doppler ultrasonoscope was done before operation and on the 4th to 7th days after operation respectively.Results: FIB, concretion startup time (CST) and maximum extent of coagulation (MCE) had no significant difference between the two groups(P>0.05). At closing chest and after operation, compared with GA group maximum coagulation time (MCT) of GEA group obviously extended (P<0.05), PLT was significantly decreased (P<0.01),the balance time (BLT) and the whole time of fibrinolysis reaction (WFT) were obviously shortened (P<0.01). The formation rate of postoperative deep venous thrombosis (DVT) of GEA group was significantly lower than that of GA group (P<0.05).Conclusion: TEA can inhibit increase in coagulation induced by stress, improve postoperative inhibition of fibrinolysis, and keep intracorporal coagulation and fibrinolysis dynamic balance. PART TWO: DYNAMIC MONITORING THE DIAGNOSIS VALUE OF D-DIMER AND COAGULATION -FIBRINOLYSIS PARAMETER ON DEEP VENOUS THROMBOSISObjective: To observe the early diagnosis value of the dynamic change of D-Dimer(DD) and Coagulation -fibrinolysis parameters on deep venous thrombosis (DVT)after an open chest operation.Methods: Check and measure the blood plasma DD, fibrinogen(FIB), prothrombin time (PT), activated partial thromboplastin time (APTT) , thrombin time(TT) and concretion startup time (CST), maximum extent of coagulation (MCE), maximum coagulation time (MCT), the balance time (BLT) and the whole time of fibrinolysis reaction (WFT) of 40 patients undergoing thoracotomy (esophageal cancer radical correction and lobectomia pulmonalis) in pre-operation, closing chest, the 1st and 3rd days of post-operation. In pre-operation, the lower-limb deep venous color supersonic check results of all patients'were negative. According to the results of postoperative lower-limb color supersonic check from the 4th to the 7th day in post-operation, the patients were divided into Team Thrombosis (Team T) (n=13) and Team Not thrombosis (Team NT) (n=27).Results: Compared with Team NT, the DD of Team T in each time points of after operation rised obviously (P<0.01～0.05), the FIB of the 3rd day in post-operation increased obviously (P < 0.05); Compared with the basic value, the DD,FIB,MCE,BLT and WFT of both team in each time points after operation rised obviously (P<0.01～0.05), the PT and APTT shortened obviously after the 1st day in post-operation (P<0.01～0.05) , the TT shortened obviously after the 3 rd day in post-operation (P<0.01).Conclusion: Dynamic monitoring the blood plasma DD possess the early diagnose value of DVT after the thoracotomy, but Coagulation-fibrinolysis parameters have no early diagnose value of DVT, furthermore, all the parameters indicate that hypercoagulabale state appears in the blood after the thoracotomy.