CO_2气腹对机体血流动力学、凝血-纤溶系统的影响  

Influence of carbon dioxide pneumoperitoneum during laparoscopic surgery on hemodynamic changes and coagulation-fibrinolytic parameters

作　　者：袁金灵 韩萍[1] 白洁[1] 

机构地区：[1]河北联合大学附属医院,河北唐山063000

出　　处：《腹腔镜外科杂志》2015年第3期194-197,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜与开腹手术治疗良性卵巢囊肿及子宫肌瘤对血流动力学、腹膜凝血-纤溶系统的影响。方法:选取49例腹腔镜手术患者(腹腔镜组)与43例开腹手术患者(开腹组),分别于术前、术后进行D-二聚体(D-dimer,D-D)测定、血气分析,采集壁层腹膜行组织型纤溶酶原激活物(tissue type plasminogen activator,t-PA)、尿激酶型纤溶酶原激活物(urinary type plasminogen activator,u-PA)检测。结果:与术前相比,两组患者术后D-D均升高,差异有统计学意义(P<0.05);两组间相比差异无统计学意义。两组术后t-PA、u-PA阳性率差异无统计学意义。与气腹前相比,气腹后PCO2、p H均有显著变化(P<0.01),且PCO2的改变与通气时间的相关性最高;术后腹腔镜组p H值明显低于开腹组(P<0.05),两组患者组内、组间PO2均无显著变化。结论:腹腔镜手术与传统开腹手术均可对血气产生影响,但对凝血-纤溶系统的影响差异无统计学意义。Objective： To investigate the influence of laparoscopic and open operation on hemodynamics,peritoneal coagulationfibrinolysis system in the treatment of benign ovarian cyst and uterine fibroids. Methods： Forty-nine patients were selected in the laparoscopic group,and 43 patients were selected in the laparotomy therapy group,D-dimer（ D-D） level,blood gas analysis,tissue type plasminogen activator（ t-PA）,urinary type plasminogen activator（ u-PA） were detected before and after treatment respectively. Results：Inner-group comparisons showed that,in the two groups,D-D level after treatment increased,the differences were statistically significant（ P〈0. 05）. Inter-group comparisons showed that,D-D level of the two groups after treatment had no significant difference,positive rate of t-PA and u-PA in the two groups had no significant difference. Before and after pneumoperitoneum,PCO2 and p H were significantly different（ P〈0. 01）,and change of PCO2 was highly correlated with duration of ventilation. After treatment,p H of the laparotomy therapy group was significantly higher than that of the laparoscopic group（ P〈0. 05）,PO2 of the two groups did not significantly changed.Conclusions： Laparoscopic and open operations have influence on blood gas,but have no significant effect on coagulation-fibrinolysis system.

关 键 词：二氧化碳 气腹 血流动力学 凝血-纤溶系统 

分 类 号：R737.3[医药卫生—肿瘤]