ANESTHESIA/ANALGESIA EFFECTS ON PERIOPERATIVE HEMOSTASIS

手术会引起止血功能的改变，这与 术后动、静脉血栓并发症。这些 并发症会导致严重的发病率和死亡率。因为 围手术期凝血、纤溶和血小板功能的变化 似乎受术中麻醉类型的影响 术后止痛，存在降低发生率的潜力 这些复杂的情况。这项调查探索了这一关系 围手术期止血功能变化与术后的关系 动脉血栓并发症，并寻求定义最佳 麻醉/止痛方案。我们提出了两项临床研究来回答 具体目标。第一项是240例的双盲临床试验 接受腹主动脉手术的患者。受试者将被随机化 给四个小组中的一个，接受区域补充普通 手术中单独麻醉或全身麻醉，且 静脉麻醉或硬膜外局部麻醉病人的控制 术后止痛。围手术期管理的方方面面都将 通过协议进行标准化，以确保一致的临床护理。数据 收集将包括96小时连续Holter监测，连续 心电图、体格检查和心脏同工酶测定 监测临床上重要的血栓事件。纤维蛋白原、凝血酶原 接下来是碎片(F1.2)、纤溶和血小板反应性 在整个围手术期评估止血效果。第二个是 用双盲研究评价局部电针的调制效应 麻醉剂和麻醉剂对应激激素引起的止血变化的影响。 20名正常志愿者将接受三次(24小时)的注射 Epinephrine-cortisol-glucagon-vasopressin-angiotensin-II鸡尾酒，In 联合静脉注射布比卡因、芬太尼或安慰剂。这 输液模式增加止血功能的循环措施 将使我们能够确定布比卡因和芬太尼是否调节 止血。在基线、2小时、8小时和24小时进行全血检测 全血细胞计数、纤维蛋白原、血小板反应性和纤溶。 随着这两项研究的完成，我们希望1)确定 围手术期止血功能与术后的关系 动脉血栓形成并发症，2)阐明其调节作用。 麻醉药和镇痛剂对止血功能及并发症发生率的影响 术后动脉血栓并发症，以及3)确定最佳的 围手术期治疗方案。

Surgery causes changes in hemostatic function that are associated with postoperative arterial and venous thrombotic complications. These complications cause significant morbidity and mortality. Inasmuch as perioperative changes in coagulation, fibrinolysis and platelet function appear to be modulated by the type of intraoperative anesthesia and postoperative analgesia, the potential exists for decreasing the incidence of these complications. This investigation explores the relationship between perioperative changes in hemostatic function and postoperative arterial thrombotic complications, and seeks to define the optimal anesthetic/analgesic regimen. We propose two clinical studies to answer the specific aims. The first is a double-blind clinical trial of 240 patients undergoing abdominal aortic surgery. Subjects will be randomized to one of four groups to receive either regional supplemented general anesthesia or general anesthesia alone during surgery, and either intravenous narcotic or epidural local anesthetic patient controlled analgesia postoperatively. All aspects of perioperative management will be standardized by protocol to insure consistent clinical care. Data collection will include 96 hours of continuous holter monitoring, serial ECG's, physical examinations and measurement of cardiac isoenzymes to monitor clinically important thrombotic events. Fibrinogen, prothrombin fragment (F1.2), fibrinolysis, and platelet reactivity will be followed throughout the perioperative period to assess hemostasis. The second is a double-blind study to evaluate the modulating effects of a local anesthetic and narcotic on stress hormone-induced changes in hemostasis. Twenty normal volunteers will receive three infusions (24-hour) of an epinephrine-cortisol-glucagon-vasopressin-angiotensin-II cocktail, in combination with intravenous bupivacaine, fentanyl, or placebo. This infusion paradigm increases circulating measures of hemostatic function and will enable us to determine whether bupivacaine and fentanyl modulate hemostasis. Whole blood will be assayed at baseline, 2, 8 and 24 hours for complete blood count, fibrinogen, platelet reactivity and fibrinolysis. With completion of these two studies, we hope to 1) determine the relationship between perioperative hemostatic function and postoperative arterial thrombotic complications, 2) elucidate the modulating effects of anesthetics and analgesics on hemostatic function and the incidence of postoperative arterial thrombotic complications, and 3) define an optimal perioperative regimen.