人工气胸对食管癌切除术患者围术期凝血-纤溶功能的影响

Effect of artificial pneumothorax on perioperative coagulation-fibrinolysis in patients with esophagectomy

目的观察CO2人工气胸对胸腹腔镜联合食管癌切除术患者围术期凝血-纤溶功能的影响。方法选择2017年11月至2018年6月我院择期行胸腹腔镜联合食管癌切除术患者80例,随机分为CO2人工气胸组(P组)和非CO2人工气胸组(N组),每组40例,分别于麻醉前(T1)、人工气胸开始60min后或单肺通气60min后(T2)、人工气胸停止30min后或双肺通气30min后(T3)、术后第1天(T4)、第3天(T5)5个时间点测定患者组织型纤溶酶原激活物(t-PA)、纤溶酶原激活剂抑制物(PAI-1)、血栓弹力图(TEG)、D2-聚体(D-D)及血气分析。结果与N组相比,P组于人工气胸开始60min后(T2)pH值明显降低(P<0.05),PaCO2明显增高(P<0.05),TEG测定R值和K值显著延长(P<0.05),α角、MA值显著减小(P<0.05),t-PA明显升高(P<0.05);人工气胸结束30min后,pH值、PaCO2和t-PA逐渐恢复至术前水平(P>0.05);术后第1天TEG测定R值、K值、α角、MA值恢复至术前水平(P>0.05);2组术后D-D均显著升高(P<0.05),但组间比较差异无统计学意义(P>0.05)。结论CO2人工气腹建立后导致的呼吸性酸中毒可使患者术中凝血功能显著降低,纤溶功能增强,术后第1天恢复至术前水平。

Objective To observe the effect of CO 2 artificial pneumothorax on perioperative coagulation-fibrinolysis in patients undergoing thoracoscopic esophagectomy.Methods A total of 80 patients with thoracic-laparoscopic combined esophageal resection in our hospital from November 2017 to June 2018 were randomly divided into CO 2 artificial pneumothorax group(P group)and non-CO 2 artificial pneumothorax group(N group),40 cases in each group.The patient′s tissue plasminogen activator(t-PA),plasminogen activator inhibitor(PAI-1),thromboelastogram(TEG),Polymer(D-D)and blood gas analysis were measured at 5 time points included before anesthesia(T1),artificial pneumothorax 60 minutes or single lung ventilation 60 minutes(T2),artificial pneumothorax stop 30 minutes or double lung ventilation 30 minutes(T3),postoperative first day(T4)and postoperative third day(T5).Results Compared with the N group,the pH value of the P group was significantly decreased at T2(P<0.05),the PaCO 2 was significantly increased(P<0.05),and the R and K values of the TEG were significantly prolonged(P<0.05),the angle and MA decreased significantly(P<0.05),t-PA increased significantly(P<0.05).After 30 minutes of artificial pneumothorax,the pH value,PaCO 2 and t-PA gradually recovered to the preoperative level(P>0.05).On the first day after operation,the R value,K value,αangle and MA value of TEG were restored to the preoperative level(P>0.05).The postoperative D-D was significantly increased in both groups(P<0.05),but there was no statistically significant difference between two groups(P>0.05).Conclusion Respiratory acidosis caused by the establishment of CO 2 pneumoperitoneum can significantly reduce the coagulation function of patients during the operation,enhance the fibrinolysis function,and return to the preoperative level on the first day after the operation.