전신적 동맥경화성 혈관염 환자의 수술 후 경막외마취가 혈액응고에 미치는 효과

Abstract

Background: The purpose of this study was to examine the relationship of epidural anesthesia with coagulation status and surgery outcome following lower extremity revascularization. Methods: Twenty patients with arteriosclerosis obliterance (ASO) scheduled for lower extremity vascular reconstruction were randomized to receive either general anesthesia or combined genetal-epidural anesthesia. An additional 20 randomly selected patients without atherosclerotic vascular disease undergoing lower abdominal or lower extremity surgeiy served as controls for coagulation status. In the group with general anesthesia, anesthesia was induced by administration of pentothal sodium and succiny-Icholitie and maintained with N2O-O2, isofhirane and vecuronium. In the group with combined anesthesia, epidural anesthesia was performed at the level of L2-3 or L3-4 epidural space using 2% lidocaine, followed by general anesthesia same as general group. Postoperative pain control was followed by on-demand oral or intravenous narcotics in the general group and followed by epidural 0.125% bupivacaine and morphine in the combined group. The coagulation status was monitored using thrombelastography (TEG) and standard coagulation tests. Results: The ASO patients were hypercoagulable compared to the control patients before operation and on the first postoperative day. Hie hypercoagulability was attenuated postoperatively in the combined group. In the ASO-general group, postoperative MA, a and TEG index were 69.5 士 6.1 mm, 53.3 士 7.5° and 1.18 土 1.29 respectively, but in the ASO-combined anesthesia group, they were 58.0 土 62 mm, 38.0 土 4.0 ‘ and -0.38 土 1.20 respectively (P < 0.05). The rates of postoperative complications did not significantly differ between the two groups. Conclusions: In patients with arteriosclerosis obliterance undergoing arterial reconstructive surgeiy, thrombelastographic evidence of increased platelet-fibrinogen interaction is associated with early postoperative thrombotic events, and epidural anesthesia is associated with beneficial effects on coagulation status.