不同压力二氧化碳气腹对腹腔镜胆囊切除术患者凝血及纤溶功能的影响

Effect of different pressures of carbon dioxide pneumoperitoneum on blood coagulation and fibrinolysis function in patients with laparoscopic cholecystectomy

目的观察不同压力二氧化碳(CO_2)气腹对腹腔镜胆囊切除术患者凝血及纤溶功能的影响。方法选择择期行腹腔镜胆囊切除术患者60例,根据气腹压力不同随机分为两组:低压力组(10mm Hg)和高压力组(14mm Hg),每组30例。于术前、术后1h、术后24h抽取静脉血,检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(DD)水平,以及丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)水平。结果在各时间点,两组PT、AST、ALT水平比较,差异均无统计学意义(P>0.05)。两组术后24h的APTT较术前均明显缩短(P<0.05);两组FIB、DD水平较术前均明显升高(P<0.05),且高压力组的FIB、DD水平升高幅度显著大于低压力组(P<0.05)。结论腹腔镜胆囊切除术低气腹压力和高气腹压力均可导致术后高凝状态,但低气腹压力对凝血和纤溶功能影响较小,有利于预防静脉血栓形成。

Objective To observe the effect of different pressures of carbon dioxide pneumoperitoneum on blood coagulation and fibrinolysis function in the patients with laparoscopic cholecystectomy.Methods Sixty patients undergoing elective laparoscopic cholecystectomy were selected and randomly divided into the two groups according to the pneumoperitoneum pressure:low pressure group(10 mm Hg)and high pressure group(14 mm Hg),30 cases in each group.Venous blood samples were taken before surgery,at postoperative 1,24 h for determining the levels of prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib),DDimer(DD),alanine amino transferase(ALT),aspartate amino transferase(AST).Results The levels of PT,AST and ALT at each time point had no statistical difference between the two groups(P >0.05).Compared with before surgery,APTT at postoperative 24 h in the two groups was significantly shortened(P<0.05),while the levels of FIB and DD were increased significantly(P<0.05),moreover the increasing range of FIB and DD in the high pressure group was significantly greater than that in the low pressure group(P<0.05).Conclusion Low and high pneumoperitoneum pressure may lead to postoperative hypercoagulable status in laparoscopic cholecystectomy,but lower pneumoperitoneum pressure has less effect on blood coagulation and fibrinolysis function and is conducive to preventing the vein thrombosis.