阿司匹林不同应用情况对腹腔镜胆囊切除后凝血功能、胃肠功能的影响比较

Comparison of the effects of different application of aspirin on coagulation and gastrointestinal function in pa⁃tients with laparoscopic cholecystectomy

目的比较阿司匹林不同应用情况对腹腔镜胆囊切除对凝血功能、胃肠功能的影响。方法回顾性分析确诊胆囊结石合并胆总管结石行胆囊切除术治疗患者95例的临床资料。根据其阿司匹林不同应用情况,分为A组(围术期持续应用)36例和B组(术前1周停用)59例。比较两组手术情况,术前和术后24 h凝血功能,术后胃肠功能恢复情况,术中和术后出血发生率,并发症发生率等资料。结果两组手术时间、术中出血量、术前和术后24 h凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、血浆纤维蛋白原(FIB)等凝血功能指标比较,差异均无统计学意义(t分别=0.96、0.62、0.13、0.09、0.07、0.10、0.30、0.25、0.16、0.26,P均>0.05)。两组组内术前和术后24 h凝血功能指标比较,差异均无统计学意义(t分别=0.68、0.36、0.48、0.60;0.39、0.28、0.52、0.32,P均>0.05)。与B组比较,A组术后住院时间、肠鸣音出现时间、排气时间、进食时间均缩短(t分别=5.42、10.23、13.84、20.08,P均<0.05);术后深静脉血栓(DVT)的发生率降低,术中和术后出血发生率升高(P均<0.05)。两组切口感染率和心脑血管并发症发生率比较,差异均无统计学意义(P均>0.05)。结论围术期阿司匹林持续应用于腹腔镜胆囊切除有利于促进术后胃肠功能恢复和DVT的预防,但可能增加术中和术后出血风险。

Objective To compare the effects of different application of aspirin on coagulation and gastrointestinal func-tion in patients with laparoscopic cholecystectomy.Methods The clinical data of 95 patients with cholecystectomy who were diagnosed with cholecystolithiasis combined with choledocholithiasis were retrospectively analyzed.According to their different application of aspirin,they were divided into group A with 36 cases(continuous application during perioper-ative period)and group B with 59 cases(stopped 1 week before operation).The operation status,the coagulation function,the recovery of gastrointestinal function after the operation,the rate of bleeding during and after the operation,the inci-dence of complications of the two groups were collected and compared.Results There were no significant differences in the operation time,intraoperative blood loss,preoperative and postoperative 24h coagulation function indexes such as pro-thrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and plasma fibrinogen(FIB)be-tween the two groups(t=0.96,0.62,0.13,0.09,0.07,0.10,0.30,0.25,0.16,0.26,P>0.05).There were no significant dif-ferences in coagulation function indexes before and 24h after operation in the two groups(t=0.68,0.36,0.48,0.60,0.39,0.28,0.52,0.32,P>0.05).Compared with group B,the postoperative hospitalization time,bowel sounds,exhaust time,and eating time in group A were shortened(t=5.42,10.23,13.84,20.08,P<0.05),and the rate of postoperative deep venous thrombosis(DVT)in group A decreased while the rate of intraoperative and postoperative bleeding in group A increased(P<0.05).There was no significant difference in the incision infection rate and incidence of cardiovascular and cerebro-vascular complications of the two groups(P>0.05).Conclusion The continuous application of aspirin during periopera-tive period of laparoscopic cholecystectomy is benefi-cial to promote postoperative gastrointestinal function recovery and prevention of DVT,but may increase the risk of intraoperative and postoperative bleeding.