手术创伤对血小板粘附功能的影响

The effects of surgical trauma on aggregation and adhesion of platelets

目的 探讨手术创伤的大小及时间长短对血小板粘附功能的影响。方法 择期胆囊切除术全麻病人３０例，随机分为ＬＣ组及ＯＣ组。两组病人均于全麻后分别采集静脉血１０ｍｌ，并于手术开始后１ｈ、２ｈ各采血１０ｍｌ，分别制备贫血小板血浆和富血小板血浆，测定ＧＰⅠｂ／Ⅰｘ、ｖＷＦ、ＰＡｄＴ。结果 ＧＰⅠｂ／Ⅰｘ、ｖＷＦ、ＰＡｄＴ麻醉后手术前均无显著性差异。手术中 ＰＡｄＴ ＬＣ组明显低于 ＯＣ组（Ｐ＜０．０５）。ＧＰⅠｂ／Ⅰｘ ＯＣ组明显高于 ＬＣ组（Ｐ＜０．０１），且随时间延长，ＯＣ组亦显著高于ＬＣ组（Ｐ＜０．０１）。ｖＷＦ以ＬＣ组减少显著（Ｐ＜０．０５），两组均在手术开始后２ｈ降低明显。结论 手术中ＧＰＩｂ／Ｉｘ、ｖＷＦ、ＰＡｄＴ的升高与降低均与创伤大小有关。

Objective To investigate the effects of magnitude of surgical trauma and duration of operation on aggregation and adhesion of platelets during laparoscopy and conventional laparotomy cholecystectomy. Methods Thirty ASA Ⅰ-Ⅱpatients(male 11, female 19) undergoing elective cholecystectomy were studied . The mean age was(45 .2 ± 8.3) years and mean body weight(63.3 ±12. 6)kg. The patients were divided into two groups: laparoscopy group(group LC) and laparotomy group(group OC). Patients who took any drugs which may affect blood coagulation were excluded. Blood routine examination, coagulation and bleeding time were normal in all patients. In both groups anesthesia was induced with fentanyl 0. 1-0.2mg, propofol 2mg/kg and vecuronium 0.1mg/kg and maintained with isoflurane inhalation. Venous blood samples were taken after induction of anesthesia and 1h and 2h after operation was started. 10ml of blood was withdrawn from median cubital vein for the measurement of platelet adhesion(PAdT) and plasma level of platelet membrane glycoprotein(GPⅠ b/Ⅰ x) and von Willebrand factor(vWF) . Venepuncture was made at first attempt without using tourniquet. Plastic syringes were used and first 2ml of blood withdrawn was discarded . Glass ball method was used for measurement of PAdT which was calculated according to the following equation: Rate of platelet adhesion(% ) = /(No. of platelet before adhesion-No. of platelet after adhesion) No. of platelet before adhesionGP Ⅰ b/Ⅰ x and vWF levels were measured using ELISA method. Results There was no significant difference in PAdT and GP Ⅰ b/Ⅰ x and vWF levels after induction of anesthesia between two group. PadT level was significantly lower at 1 and 2h during surgery in group LC than that in group OC. GPⅠh/Ⅰx level was higher at 1h during operation in group OC than that in group LC and was much higher at 2h during surgery. vWF level decreased significantly at 2h during operation in both groups. Conclusions Platelet adhesion rate increases during operation and the severer the trauma the higher the platelet adhesion rate. GPⅠ b/Ⅰ x level is higher in group OC during operation than that in group LC probably due to severity of trauma. vWF is consumed during operation.