腹腔镜气腹时间对老年胆结石患者血液相关指标的影响

Effects of laparoscopic pneumoperitoneum time on related blood indexes of elderly patients with gallstones

目的观察腹腔镜气腹时间对老年胆结石患者血液流变学、凝血和纤溶系统活性的影响。方法选择本院同一医疗组收治的胆石症腹腔镜胆囊切除术（LC）患者150例,根据手术情况所需要的气腹持续时间分组如下,Ⅰa组：≤50岁,气腹时间〈30 min;Ⅰb组：≥70岁,〈30 min;Ⅱa组：≤50岁,31-60 min;Ⅱb组：≥70岁,31-60 min;Ⅲa组：≤50岁,〉60 min;Ⅲb组：≥70岁,〉60 min。比较各组间和组内血液流变学、凝血和纤溶系统活性的差异。结果与年轻组比较,老年组血浆黏度更高,纤溶系统活性变化更大（均P〈0.05）;Ⅰ、Ⅱ、Ⅲ组组间比较,气腹时间越长,各指标越高,Ⅲ组明显高于Ⅰ组及Ⅱ组（P〈0.05）,而Ⅰ组、Ⅱ组间差异不明显。结论随二氧化碳气腹持续时间延长,患者血液流变学、凝血和纤溶系统活性有所改变;老年患者因生理变化原因,可能处于高凝状态,成为临床上发生静脉血栓的高危患者,因此,应重视并采取相应的预防措施。

Objective To observe the effects of laparoscopic pneumoperitoneum time on hemorheology, blood coagulation, and fibrinolytic system activity of elderly patients with gallstones. Methods 150 patients receiving laparoscopic cholecystectomy（LC） by the same medical team were selected, and according to the needed pneumoperitoneum duration time they were divided into Ⅰa group（≤50 years old and pneumoperitoneum time 〈30 min）, Ⅰb group（≥70 and pneumoperitoneum time 30 min）, Ⅱa group（≤50 and31-60 min pneumoperitoneum time）, Ⅱ b group（≥70 and 31-60 min pneumoperitoneum time）, Ⅲ a group（≤50 and pneumoperitoneum time 60 min）, and Ⅲ b group（≥70 and pneumoperitoneum time 〉60 min）. Comparison was made among the groups in differences of hemorheology, blood coagulation, and fibrinolysis system activity. Results Compared with the data in the younger groups, the plasma viscosity in elderly group was significantly higher and the changes in the activity of fibrinolytic system were more（all P〈 0.05）. In the comparison among Ⅰ, Ⅱ, and Ⅲ groups, the longer the pneumoperitoneum time was, the higher the indexes were. Those indexes of Ⅲ group were significantly higher than those of group Ⅰ and Ⅱ（P〈 0.05）. The differences between Ⅰand Ⅱ group were not significant. Conclusion Along with the prolongation of carbon dioxide pneumoperitoneum duration time, the patients＇ hemorheology, blood coagulation, and fibrinolytic system activity change. Elderly patients with physiological changes may be in hypercoagulable state and become the high-risk patients of venous thromboembolism, therefore corresponding preventive measures should be carried out.