二氧化碳气腹时间对腹腔镜胆囊切除术患者血液流变学的影响  

Effect of Duration of Pneumoperitoneum on Hemorheology in Patients Undergoing Laparoscopic Cholecystectomy.

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310014

出　　处：《医学研究杂志》2011年第6期56-60,共5页Journal of Medical Research

基　　金：浙江省卫生厅自然科学基金资助项目(2009A022)

摘　　要：目的观察C02气腹时间对腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）患者血液流变学的影响。方法胆石症择期行LC患者64例，年龄〈60岁，术后根据CO2气腹持续时间归组：A组（21例）：气腹时间≤30min；B组（23例）：气腹时间30～60min；C组（20例）：气腹时间≥61min。于入院检查时（基础值）、术毕、术后1天、2天及3天抽取静脉血检测血液流变学指标、血小板计数（PLT）、血细胞比容（Hct）、纤维蛋白原浓度（Fib）、D-二聚体（D—D）。结果各组血浆和全血黏度、Fib于术毕均低于基础值（P〈0．05），A组术后的全血和血浆黏度、红细胞聚集指数、Fib及D—D无明显变化；B组术后1天、2天的D—D高于基础值（P〈0．05）；C组术后1天的血浆黏度、红细胞聚集指数高于基础值（P〈0．05），术后2天和3天的Fib及D—D高于基础值（P〈0．05）。c组的血浆黏度于术后1天高于A组，Fib及D—D于术后2天和3天高于A组，术后3天的D—D高于B组（P〈0．05）。A、B两组间各指标无明显差异。结论全身情况良好的LC手术患者，手术时间短时，血液流变学指标变化不明显；而随手术时间延长，术后Fib和D-二聚体明显增高，全血和血浆黏度增加，提示静脉血栓发生的风险增加。Objective To observe the effect of duration of pneumoperitoneum on hemorheology in patients undergoing laparoscopie cholecystectomy（LC）. Methods Sixty- four patients with cholelithiasis scheduled for LC without systematic disease,aged 〈 60 yeas, were placed in different groups respeetively after surgery according to the duration of pneumoperitoneum. In group A （21 cases） , duration of pneumoperitoneum was ≤ 30min ;in group B （23 cases） , duration of pneumoperitoneum was 30 - 60rain and in group C （20 cases） , duration of pneumoperitoneum was ≥ 61min. Venous blood samples were taken at examination on admission （baseline） , at the end of surger- y, postoperative 1 d, 2d and 3d for determination of hemorheology, blood platelet count （PLT） , hematoerit （Her） , prothrombin time （PT） , activated partial thromboplastin time（APTT） ,fibrinogen （Fib）,D -dimer（ D -D）. Results No significant difference was found in the baseline values of each parameter among the three groups. Compared with baseline values, plasma and whole blood viscosity were de- creased in the three groups at the end of surgery （ P 〈 0.05 ） , and there was no significant difference in p]asma and whole blood viscosity, erythroeyte aggregation index,Fib and D -D after surgery in group A. There was significant increase in D -D 2d postoperation in group B compared with baseline values （P 〈 0. 05 ）. Plasma viscosity and erythrocyte aggregation index on 1 d, Fib and D - D on 2d and 3d postop- eration increased significantly in group C compared with baseline values. In group C, plasma viscosity on ld, Fib and D - D on 2d and 3d postoperation were higer than those in group A （ P 〈 0.05 ） , D - D on 3d postoperation was higer than that in group B （ P 〈 0. 05 ）. There was no significant difference in parameters of hemorheology between group A and B. Conclusion Postoperative hemorheology didn＇t change pronouncedly when with short duration of pneumoperitoneum in patients undergoing LC. While F

关 键 词：腹腔镜胆囊切除 气腹 血液流变学 

分 类 号：R135.2[医药卫生—劳动卫生]