不同二氧化碳气腹时间胆囊切除术患者凝血纤溶功能和血管内膜损伤的比较  

Comparison of changes in blood coagulation, fibrinolysis and endothelial damage in patients undergoing laparoscopic cholecystectomy with different durations of carbon dioxide pneumoperitoneum

作　　者：严美娟[1] 楼小侃[1] 陈悦[1] 于泳健[1] 费鲜明[1] 

机构地区：[1]浙江省人民医院麻醉科,杭州市310014

出　　处：《中华麻醉学杂志》2011年第3期299-302,共4页Chinese Journal of Anesthesiology

基　　金：浙江省卫生厅自然科学基金（2009A022）

摘　　要：目的比较不同二氧化碳气腹时间胆囊切除术患者的凝血纤溶功能和血管内膜损伤程度。方法择期拟行腹腔镜胆囊切除术患者64例，年龄23—60岁，体重45—82kg，ASA分级Ⅰ或Ⅱ级，根据气腹持续时间不同分为3组：气腹时间≤30min组（Ⅰ组，n=21）、30min〈气腹时间〈60min组（Ⅱ组，n=23）和气腹时间≥60min组（Ⅲ组，n=20）。气腹压力维持12—14mmHg，分别于术前（T0）、术毕（T1）、术后1、2、3d（T2-4）时抽取静脉血样，测定凝血酶原时间、激活部分凝血活酶时间、血浆凝血酶原片段1＋2（F1＋2）、纤维蛋白原（Fib）、组织纤溶酶原激活物和纤溶酶原激活物抑制物-1（PAI-1）的浓度和抗凝血酶-Ⅲ（AT-Ⅲ）、血管性血友病因子（vWF）的活性。结果与I组比较，Ⅲ组T2时vWF活性和PAI-1浓度升高，L时Fib、F1＋2、PAI-1浓度和vWF活性升高，AT-Ⅲ活性降低，T4时Fib和F1＋2浓度升高（P〈0．05）；与Ⅱ组比较，Ⅲ组上述指标差异无统计学意义（P〉0．05）。结论气腹时间短时胆囊切除术后患者凝血纤溶功能变化小，血管内膜损伤不明显；随气腹时间延长，凝血功能增强，纤溶功能受抑制，血管内膜损伤加重。Objective To compare the changes in blood coagulation, fibrinolysis and endothelial damage in patients undergoing laparoscopic cholecystectomy with different durations of carbon dioxide pneumoperitoneum. Methods Sixty-four ASA Ⅰ or Ⅱpatients, aged 23-60 yr, weighing 45-82 kg, scheduled for elective laparoscopic cholecystectomy, were randomly divided into 3 groups according to the duration of pneumoperitoneum ： duration of pneumoperitoneum ≤30 min group （group Ⅰ , n = 21）, 30 min 〈 duration of pneumoperitoneum 〈 60 min （group Ⅱ , n = 23） and duration of pneumoperitoneum≥ 60 min （group m, n = 20〉. The intra-abdominal pressure was maintained at 12-14 mm Hg. Venous blood samples were taken before surgery （baseline, T0）, at the end of surgery （T1）, and at 1, 2 and 3 d after surgery （T2-4） for determination of prothrombin time, activated partial thromboplastin time, concentrations of prothrembin fragment 1 ＋ 2 （F1 ＋ 2）, fibrinogen （Fib）, tissue plasminogen activator and plasminogen activator inhibitor type-1 （PAI-1）, and activities of antithrembin m 〈 AT-m ） and von Willebrand factor （vWF）. Results Compared with group I , the vWF activity and PAI-1 concentration at T2, concentrations of Fib, F1 ＋ 2, PAI-1 and activity of vWF at T3 and concentrations of Fib and F1 ＋ 2 at T4 were significantly increased, while the AT- m activity at T3 was significantly decreased in group m 〈 P 〈 0.05） Conclusion When the duration of pneumoperitoneum is short, no obvious changes in the blood coagulation, fibrinoly- sis and endothelial damage are observed postoperatively in patients undergoing laparoscopic cholecystectomy, and along with the prolongation of the duration of pnemnoperitoneum, increased blood coagulation, reduced fibrinolysis and aggravated endothelial damage are observed postoperatively.

关 键 词：气腹 人工 腹腔镜检查 血液凝固试验 纤维蛋白溶解 血管内膜 

分 类 号：R614[医药卫生—麻醉学]