Abstract:

Objective　To compare the effects of general anesthesia and epidural anesthesia on the surgical outcomes and coagulation function of elderly patients undergoing total hip replacement surgery. Method　This study utilized a randomized controlled design, selecting 96 elderly patients scheduled for elective total hip arthroplasty at the Yulin Hospital of Xi'an Jiaotong University First Affiliated Hospital from April 2023 to April 2024. Patients were divided into group A (general anesthesia group) and group B (epidural anesthesia group) using a random number table, with 48 cases in each group. Group A comprised 28 males and 20 females, aged (68.41±4.04) years; American Society of Anesthesiologists (ASA) classification included 27 cases of ASA II and 21 cases of ASA III. Group B included 27 males and 21 females, aged (68.55±4.17) years; ASA classification included 28 cases of ASA II and 20 cases of ASA III. Group A was given general anesthesia by tracheal intubation, and group B was given epidural anesthesia. The surgical-related indicators, coagulation function levels, and incidence of lower limb deep venous thrombosis were compared between the two groups. Statistical analysis was performed using χ² test and t test. Result　There were no statistically significant differences between the two groups in terms of surgical time, anesthesia time, intraoperative blood loss, and time to ambulation (all P>0.05). At 72 hours post-anesthesia, the platelet aggregation rate in group B was lower than that in group A [(65.92±8.34)% vs. (75.28±7.39)%,] with a statistically significant difference (t=5.820, P<0.001). At 24 hours post-anesthesia, the prothrombin time, prothrombin activity, fibrinogen, activated partial thromboplastin time, thrombin time, and D-dimer levels in group B were (14.22±1.08) s, (108.54±9.15)%, (4.24±0.83) g/ml, (37.92±1.84) s, (18.79±1.64) s, and (0.84±0.13) mg/L, respectively, while in group A they were (12.91±1.38) s, (97.48±11.26)%, (5.23±0.79) g/ml, (33.96±5.39) s, (14.68±1.41) s, and (1.49±0.58) mg/L, with all differences being statistically significant (all P<0.05). The incidence of lower limb deep venous thrombosis in group B was [2.08% (1/48)], which was lower than that in group A [14.58% (7/48)], with a statistically significant difference (χ²=4.909, P=0.027). Conclusion　In elderly patients undergoing total hip arthroplasty, both general anesthesia and epidural anesthesia interventions effectively ensure the smooth progress of surgery. However, epidural anesthesia better stabilizes postoperative platelet aggregation rates, improves the coagulation status of patients, prevents the occurrence of lower limb deep venous thrombosis, and ensures better prognostic outcomes.

Key words:

General anesthesia, Epidural anesthesia, Total hip replacement surgery, Anesthetic effect, Coagulation function, Old age

摘要：

目的　针对老年全髋关节置换术患者，对比全身麻醉和硬膜外麻醉方法对手术效果及凝血功能的影响。方法　本研究采用随机对照研究，选取西安交通大学第一附属医院榆林医院2023年4月至2024年4月拟择期行全髋关节置换术的老年患者96例，采用随机数字表法将患者分为A组（全麻组）和B组（硬膜外组），每组48例。A组男28例，女20例，年龄（68.41±4.04）岁；美国麻醉师学会（ASA）分级：Ⅱ级27例，Ⅲ级21例。B组男27例，女21例，年龄（68.55±4.17）岁；ASA分级：Ⅱ级28例，Ⅲ级20例。A组采用气管插管全身麻醉，B组采用硬膜外麻醉。比较两组患者手术相关指标、凝血功能指标水平和下肢深静脉血栓发生情况。采用χ²检验、t检验进行统计分析。结果　两组手术时间、麻醉时间、术中出血量、下床时间差异均无统计学意义（均P>0.05）。麻醉后72 h，B组的血小板聚集率低于A组［（65.92±8.34）%比（75.28±7.39）%］，差异有统计学意义（t=5.820，P<0.001）。麻醉后24 h，B组的凝血酶原时间、凝血酶原活动度、纤维蛋白原、活化部分凝血活酶时间、凝血酶时间、D-二聚体分别为（14.22±1.08）s、（108.54±9.15）%、（4.24±0.83）g/ml、（37.92±1.84）s、（18.79±1.64）s、（0.84±0.13）mg/L，A组分别为（12.91±1.38）s、（97.48±11.26）%、（5.23±0.79）g/ml、（33.96±5.39）s、（14.68±1.41）s、（1.49±0.58）mg/L，差异均有统计学意义（均P<0.05）。B组下肢深静脉血栓发生率低于A组［2.08%（1/48）比14.58%（7/48）］，差异有统计学意义（χ²=4.909，P=0.027）。结论　针对老年全髋关节置换术患者，全身麻醉和硬膜外麻醉均能有效确保手术顺利开展，但硬膜外麻醉方式能够更好地稳定术后血小板聚集率，改善患者机体凝血状态，预防下肢深静脉血栓发生，确保预后效果。

关键词:

全身麻醉, 硬膜外麻醉, 全髋关节置换术, 麻醉效果, 凝血功能, 老年