腹腔镜胆囊切除术后患者血液高凝状态的危险因素分析

Analysis of risk factors of postoperative hypercoagulable status after laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术后患者血液高凝状态的危险因素。方法选择2012年4月至2013年2月于首都医科大学附属北京世纪坛医院行腹腔镜胆囊切除术患者50例，所有患者均采用全身麻醉，使用Stroze腹腔镜设备，由1名主任医师采用标准4孑L法完成手术。根据术后血液是否高凝状态分为高凝组和非高凝组，各25例。比较2组患者一般资料、既往病史、术前生化指标和术中情况。对可能影响血液高凝状态的因素进行单因素分析，再将有统计学意义的因素进行多因素Logistic回归分析。结果2组一般资料和术中情况比较，差异均无统计学意义（均P〉0．05）。高凝组高脂血症史患者比例、总胆固醇水平高于非高凝组[44．0％（11／25）比4．0％（1／25）、（5．2±1．3）mmol／L比（4．4±1．2）mmol／L]，高密度脂蛋白胆固醇（HDL—C）水平低于非高凝组、低密度脂蛋白胆固醇（LDL—C）水平高于非高凝组[（1．0±0．3）mmol／L比（1．5±0．7）mmol／L、（3．2±1．3）mmol／L比（2．5±0．8）mmol／L]，差异均有统计学意义（均P〈0．05）。单因素回归分析显示：年龄≥57岁、术前收缩压≥127mmHg（1mmHg=0．133kPa）、高脂血症史、术前HDL—C≤1．25mmol／L、术前LDL—C≥2．84mmol／L与术后血液高凝状态相关[比值比（OR）=3．273、5．464、18．857、5．091、3．187，均P〈0．05]。多因素Logistic回归分析显示：术前收缩压≥127mmHg[OR=1．079，95％置信区间（CI）：1．018～1．143]、高脂血症史（OR=19．390，95％CI：1．919～195．938）、术前LDL—C≥2．84mmol／L（OR=2．429，95％CI：0．828～7．131）为腹腔镜胆囊切除术后患者血液高凝状态的危险因素（均P〈0．05）。结论术前收缩压≥127mmHg、LDL—C≥2．84mmol／L、高脂血症史可能是腹腔镜胆囊切除术患者术后发生血液高凝状态的危险因素。

Objective To explore the risk factors of postoperative hypercoagulable status in patients after laparoscopic cholecystectomy. Methods Totally 50 cases who underwent laparoscopic cholecystectomy under general anesthesia from April 2012 to February 2013 were enrolled. The operations were completed using standard 4-hole method by the same doctor with Stroze laparoscopic equipment. The patients were divided into hypercoagulable group and non-hypercoagulable group （25 cases in each groups）. The general informations, past medical histo- ry, preoperative biochemical indicators and intraoperative conditions were compared between groups. Single factor analysis and multivariate Logistic regression were used to analyze the risk factors of blood hypercoagulable status. Results The general information and intraoperative conditions were not significantly different between groups （ P 〉 0. 05）. The proportion of hyperlipidemia, the level of total cholesterol and low density lipoprotein cholesterol （LDL-C） were significantly higher, the level of high density lipoprotein cholesterol was significantly lower in hypercoagulable group than those in non-hypercoagulable group [44. 0% （ 11/25 ） vs 4. 0% （ 1/25 ）, （5.2 ± 1.3） mmol/L vs （4. 4 ± 1.2） mmol/L, （3.2 ± 1.3） mmol/L vs （2. 5 ±0. 8） mmol/L, （ 1.0 ±0. 3） mmol/L vs （ 1.5 ± 0. 7 ） mmol/L ] （ P 〈 0. 05 ）. Single-factor retrospective analysis showed that age ≥ 57 years, preoperative systolic blood pressure 1〉 127 mmHg, history of hyperlipidemia, preoperative HDL-C ≤ 1.25 mmol/L, preoperative LDL-C ≥2. 84 mmol/L were correlated with postoperative hypercoagulable status [ odds ratio（OR） = 3. 273, 5. 464, 18. 857, 5. 091, 3. 187, P 〈 0. 05 ]. Multivariate Logistic regression analysis showed that preoperative systolic blood pressure ≥ 127 mmHg [ OR = 1. 079, 95% confidence interval （CI） ： 1. 018-1. 143 ） ], history of hyperlipemia（ OR = 19. 390, 95% CI： 1. 919-195. 938） and preoperative LDL-C ≥2. 84 mmol/L [ OR = 2. 429, 95% CI： 0. 828-7. 131 1 were the independent risk factors of postoperative hypercoagulable status （ P 〈 0. 05 ）. Conelusion Preoperative systolic blood pressure ≥ 127 mmHg, history of hyperlipemia and LDL-C≥ 2.84 mmol/L are independent risk factors of postoperative hypercoagulable status in patients who underwent laparoscopic eholecysteetomy.