腹腔镜胆囊切除术围手术期D-二聚体及其他凝血指标的变化  

The variation of D-dimer and other coagulation indexes in perioperative period of laparoscopic cholecystectomy

作　　者：万厚民[1] 张应丽[1] 高静[1] 李金文[1] 

机构地区：[1]济南市第四人民医院,山东济南250031

出　　处：《腹腔镜外科杂志》2014年第6期447-450,共4页Journal of Laparoscopic Surgery

基　　金：济南市卫生局发展计划项目(编号:2005-60)

摘　　要：目的:通过对围手术期D-二聚体(D-dimer,DD)、血浆凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、血浆纤维蛋白原(fibrinogen,Fg)的测定,指导围手术期止血活血药物的应用,从而有效减少出血并预防深静脉血栓形成及肺栓塞。方法:采用Symex CA7000对15例腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)与15例开腹胆囊切除术(open cholecystectomy,OC)患者分别于术前及术后第1天、第3天、第5天进行PT、APTT、Fg及DD测定。结果:术后PT、APTT虽略有延长,但术前、术后相比差异无统计学意义;Fg、DD术后呈逐渐升高态势,至第3天达高峰,第5天多回降,但仍略高于术前。开腹组术后Fg、DD高于腔镜组,差异有统计学意义。结论:不论腹腔镜手术抑或开腹手术对凝血状态都有影响。LC、OC对PT、APTT的影响差异无统计学意义,但Fg、DD差异有统计学意义。腹腔镜手术操作对术后高凝状态的形成影响较小。术后如应用止血药物应限制在术后3 d内,3 d后应使用活血药物预防血栓形成。Objective：To instruct the use of hemostatic and anticoagulant drugs in order to effectively decrease the bleeding and prevent the deep venous thrombosis and pulmonary embolism through the perioperative supervising D-dimer （ DD）, prothrombin time （PT） ,activated partial thromboplastin time （AP3T） and fibrinogen （Fg）. Methods： Thirty patients involved this study were divided into two groups randomly. 15 patients were performed laparoscopic cholecystectomy and the other 15 cases were performed open cholecystectomy. PT, APTT, Fg and DD were detected by Symex CA7000 at the following time points：the day before operation, the first, third and fifth day after operation. Results ：There were no statistically significant differences in PT and APTT between preoperation and postoperation although they elevated slightly after operation;Fg and DD had the statistically significant difference between preoperation and postoperation,and both of them increased and reached the peak at the third postoperative day and then descended;Fg and DD in open group were higher than those in laparoscopic group, the differences were statistically significant. Concinsions： It will cause the postoperative hypercoagulation regardless of laparoscopic procedure or open one. The laparoscopic procedure is better than the open one in decreasing hypercoagulative state;the PT and APTT have no statistical differences between before and after surgery and the two procedures. While the Fg and DD are just the reverse. As to hemostatic,if necessary, should be used within 3 d after operation and then the decongestant followed.

关 键 词：胆囊切除术 腹腔镜 围手术期 D-二聚体 

分 类 号：R657.4[医药卫生—外科学]