手术期间输注不同剂量晶体液对腹腔镜胆囊切除术患者凝血及肾功能的影响

Effect of perioperative infusion of different doses of crystalloid solutions on coagulation and renal function in patients undergoing laparoscopic cholecystectomy

目的研究手术期间输注不同剂量晶体液对手术患者凝血及肾功能的影响。方法择期腹腔镜胆囊切除术患者200例,随机均分为限制晶体组(S组)和开放晶体组(L组),术中分别输注复方乳酸钠5ml·kg-1·h-1(S组)和30ml·kg-1·h-1(L组)。常规监测两组患者的MAP、HR、PETCO2、BIS等。监测术前1d及术后第1天患者的凝血功能和肾功能变化。结果与术前1d比较,术后第1天两组凝血酶原时间(PT)明显延长,凝血酶原时间国际标准化比值(PT-INR)明显升高(P<0.01),纤维蛋白原(FIB)及抗凝血酶Ⅲ活性(AT-ⅢA)明显降低(P<0.01),但仍都在正常范围内。与S组比较,术后第1天L组APTT延长(P<0.05),但仍在正常范围内。两组凝血酶时间(TT)差异无统计学意义。术后第1天两组尿酸(UA)明显低于术前1d(P<0.01),但仍在正常范围;两组尿素(UREA)及肌酐(Cr)组间组内差异无统计学意义。结论术前凝血及肾功能正常的患者在腹腔镜胆囊切除术期间输注不同剂量的晶体液不会影响其术后的凝血功能及肾功能。

Objective To study the effect of perioperative infusion of different doses of crystalloid solutions on coagulation and renal function in patients undergoing laparoscopic cholecystectomy.Methods Two hundred patients undergoing laparoscopic cholecystectomy were randomly allocated to either receive restrictive crystalloid solution （group S） or liberal crystalloidsolution （group L） with lactated Ringer＇s solution （LR） 5 ml· kg-1 · h-1 and 30 ml·kg-1· h-1 respectively.Non-invasive MAP,HR,PETCO2 and BIS was monitored during anesthesia.Coagulation and renal function were evaluated before operation and on the first postoperative day.Results Prothrombin time （PT） and prothrombin time-international normalized ratio （PT-INR） were prolonged significantly after operation in both groups （P＜0.01）.Fibrinogen （FIB） and fibrinogen antithrombin Ⅲ （AT-Ⅲ A） activity also decreased notably in both groups （P＜0.01）.But all parameters were still in normal ranges.There was no statistically significance of thrombin time （TT） postoperatively.Furthermore,the postoperative APTT was longer in group L than that in group S.Uric acid （UA） decreased significantly after operation in both groups （P＜0.01）,hut still in normal ranges.Urea and creatinine （Cr） had no difference between two groups.Conclusion Although postoperative coagulation parameters were prolonged and UA was decreased,but all changes were not exceeded normal ranges.There were no effects on coagulation and renal function in spite of infusion restrictive crystalloid or liberal crystalloid perioperativly.