腹腔内热灌注对腹腔镜胃癌根治术患者凝血功能的影响

Effect of hyperthermic intraperitoneal perfusion on blood coagulation in patients undergoing laparoscope-assisted radical surgery for gastric cancer

目的 评价腹腔内热灌注对腹腔镜胃癌根治术患者凝血功能的影响.方法 择期行腹腔镜胃癌根治术患者40例,年龄40～ 60岁,性别不限,体重50～80 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组（n=20）：对照组（C组）和腹腔内热灌注组（HIP组）.根治性手术操作结束后R组患者行腹腔内热灌注1h.分别于麻醉诱导前即刻（T0）、腹腔内热灌注前即刻（T1）、腹腔内热灌注1 h（T2）时取静脉血样,应用血栓弹力图进行凝血功能检测,记录R、K、α角及最大幅度（MA）.结果 与C组比较,HIP组T0和T1时R、K、α角及MA差异无统计学意义（P＞0.05）,T2时R、K升高,α角和MA降低（P＜0.05）.结论 腹腔内热灌注可改善腹腔镜胃癌根治术患者的凝血功能.

Objective To evaluate the effect of hyperthermic intraperitoneal perfusion on blood coagulation in patients undergoing laparoscope-assisted radical surgery for gastric cancer.Methods Forty patients of both sexes, aged 40-60 yr, weighing 50-80 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , undergoing elective radical surgery for gastric cancer, were equally randomized into control group （group C） and hyperthermic intraperitoneal perfusion group （group HIP）.The patients were treated with hyperthermic intraperitoneal perfusion for 1 h after the end of the radical surgery in group R.Before induction of anesthesia （T0） , immediately before hyperthermic intraperitoneal perfusion （T1）, and at 1 h of hyperthermic intraperitoneal perfusion （T2） , venous blood samples were collected, blood coagulation was measured using thromboelastography, and the reaction time, coagulation time, α angle and maximal amplitude were recorded.Results Compared with group C, no significant change was found in blood coagulation parameters at T0 and T1 （P〉0.05）, the reaction time and coagulation time were significantly increased, and α angle and maximal amplitude were decreased at T2 in group HIP （P〈0.05）.Conclusion Hyperthermic intraperitoneal perfusion can improve blood coagulation in the patients undergoing laparoscope-assisted radical surgery for gastric cancer.