高海拔地区结肠冗长症合并高原红细胞增多症患者术后大肠功能与血流动力学变化

Postoperative changes of colonic function and hemodynamics in patients with redundant colon syndrome complicated with high altitude polycythemia

目的探讨高原地区结肠冗长症合并高原红细胞增多症(high altitude polycythemia,HAPC)患者行结肠手术(腹腔镜辅助及开腹手术)后胃肠道功能恢复与人体血流动力学变化的研究。方法回顾性分析笔者所在医院于2016年9月至2020年12月间收治的360例因结肠冗长症就诊的手术患者的病例资料进行归纳总结。按照是否合并HAPC将患者分为合并HAPC组和无HAPC组各180例,比较两组患者手术前后血常规、凝血功能、手术中出血量、胃肠道功能恢复时间、术后并发症的发生和血流动力学指标。结果合并HAPC组的红细胞、血红蛋白、红细胞容积、纤维蛋白原降解产物(P-FDP)(入院第1天、术后第2、第3、第7天)与无HAPC组差异具有统计学意义(P<0.05),合并HAPC组患者的术后血氧饱和度、胃肠道功能恢复时间、术后并发症发生及术后住院时间均高于无HAPC组,差异具有统计学意义(P<0.01);合并HAPC组手术前后的平均动脉压(MAP)的差值及手术前后心率(HR)均较无HAPC组高,差异具有统计学意义(P<0.05)。结论结肠冗长症合并HAPC的患者术后肠道恢复时间较不合并HAPC患者肠道恢复时间慢,术后出现并发症的机会较高,动脉血氧饱和度降低,术后心率明显加快,手术后人体血流动力学的变化较大,所以,术前早期诊断、围手术期和手术积极干预治疗,积极监测血流动力学变化是降低HAPC患者术后并发症发生率、病死率的关键。

Objective function recovery and human hemodynamic changes in patients of redundant colon syndrome with HAPC in plateau area.MethodsA retrospective analysisof clinical data of 360 surgery patients with redundant colon syndrome from September 2016 to December 2020 was conducted.The patients complicated with HAPC were selected as the HAPCcomplicated group,and those without HAPC as HAPC-free group,with 180 cases in each group.Blood routine,blood coagulation function,blood loss during operation,recovery time of gastrointestinal function,occurrence of postoperative complications and hemodynamics indexes of 2 groups were compared before and after operation.Result group(1 d after admission,2 d,3 d and 7 d after operation)were significantly different from those of the HAPC-free group(P<0.05).Postoperative oxygen saturation,recovery time of gastrointestinal function,occurrence of postoperative complications and postoperative hospitalization time in HAPC-complicated group were all higher(longer)than the HAPC-free group,showing statistical significance(P<0.01).The difference of mean arterial pressure(MAP)and heart rate(HR)before and after operation in the HAPC-complicated group were greater or higher than those in the HAPC-free group,and the difference was statistically significant(P<0.05).Conclusion intestinal recovery time of patients with redundant colon combined with hypererythema is slower than that of patients without hypererythema,and there is a higher chance of postoperative complications,decreased arterial oxygen saturation,significantly increased postoperative heart rate,and greater changes in human hemodynamics after surgery.Therefore,early preoperative diagnosis,active surgical intervention and active monitoring of hemodynamic changes are the keys to reduce the incidence of postoperative complications and mortality in HAPC patients.