腹部手术对患者凝血和纤溶系统的影响

Effect of Abdominal Operation on Coagulation and Fibrinolysis in Patients

目的探讨腹部手术不同术式对患者凝血和纤溶系统的短期影响。方法选取2015年4月~2016年4月医院择期行腹腔镜胆囊切除术患者70例为腹腔镜组,选取2013年4月~2014年4月接受开腹胆囊切除术患者70例为开腹组,均测定术前及术后1 d、3 d活化部分凝血活酶时间(a PTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(Fbg)、D二聚体(D-D)、血浆组织型纤溶酶原激活物(t-PA)水平、纤溶酶原激活抑制物(PAI-1)水平,记录住院期间下肢深静脉血栓形成(DVT)发生率。结果两组术前及术后1 d、3 d PT、TT比较差异无统计学意义(P>0.05);两组术后1 d a PTT较术前缩短(P<0.05),但两组术后3 d比较,差异无统计学意义(P>0.05)。两组术后1 d、3 d Fbg、D-D较术前上升,且开腹组明显高于腹腔镜组(P<0.05);两组术后1 d t-PA较术前下降,PAI-1较术前上升(P<0.05),术后3d t-PA较术后1 d有所上升,PAI-1下降(P<0.05)。两组术后DVT发生率比较差异无统计学意义(P>0.05)。结论腹部手术后短期内会导致凝血和纤溶激活,但与开腹手术相比,腹腔镜手术的影响相对较小。

Objective To investigate the short-term effect of different operation modes on coagulation and fibrinolysis in patients. Methods From April 2015 to April 2016,70 patients undergoing elective laparoscopic cholecystectomy in the hospital were included into the laparoscopic group, and from April 2013 to April 2014,70 patients undergoing open cholecystectomy were included into the open group. The activated partial thromboplastin time （aprFF） , prothrombin time （PT） , thrombin time （ TT）, fibrinogen （ Fbg ） , D- dimer （D-D ）, tissue plasminogen activator （t-PA ）and plasminogen activator inhibitor （PAI-1 ）levels were determined, and the incidence of lower extremity deep venous thrombosis （DVT） during hospitalization was recorded. Results There were no significant differences in PT and T＇F between the two groups before operation, 1 d and 3 d after the operation （ P 〉 0. 05 ） ; 1 d after operation, aPTF was shorter than that before operation （P 〈 0.05 ）, but there was no significant difference between the two groups 3 d after operation （ P 〉 0. 05）. 1 d and 3 d after the operation, Fbg and D- D were higher than those before operation, and those in open group were significantly higher than the laparoscopic group （ P 〈 0.05 ） ; 1 d after operation, t- PA decreased while PAI- 1 increased（P 〈 0. 05 ）. 3 d after operation,t- PA was higher and PAI- 1 was lower than those at 1 d after operation （P 〈 0. 05 ）. There was no significant difference in the incidence of DVT between the two groups （P 〉 0.05 ）. Conclusion In short term after abdominal operation, coagulation and fibrinolysis may be activated. Compared with open operation, the effect of laparoscopic operation is relativelv less.