CO2气腹压力对腹腔镜胆囊切除术患者围术期凝血、纤溶功能及术后胃肠功能恢复的影响  

Influence of CO2 pneumoperitoneal pressure on coagulation,fibrinolysis and recovery of gastrointestinal function in patients undergoing laparoscopic cholecystectomy

作　　者：羊卫刚 YANG Weigang(Department of General Ward,Changxing County People’s Hospital,Huzhou 313100,China)

机构地区：[1]长兴县人民医院普外二病区,浙江长兴313100

出　　处：《全科医学临床与教育》2020年第4期307-310,共4页Clinical Education of General Practice

摘　　要：目的探讨CO2气腹压力对腹腔镜胆囊切除术患者围术期凝血、纤溶功能及术后胃肠功能恢复的影响。方法选择行腹腔镜胆囊切除术的慢性胆囊炎患者180例,采用随机数字表法随机分为A组(CO2气腹压力7 mmHg)、B组(CO2气腹压力10 mmHg)、C组(CO2气腹压力13 mmHg)各60例。比较三组患者围术中气腹建立前(T1)、气腹建立后30 min(T2)、术后24 h(T3)的活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、凝血酶时间(TT)、纤溶指标[纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制物-1(PAI-1)],以及术后胃肠功能恢复情况的差异。结果 C组患者T2、T3时APTT、PT、TT的水平分别低于T1时,FIB水平高于T1时,差异均有统计学意义(t分别=2.97、2.41、3.65、4.70、3.46、4.94、5.30、7.30,P均<0.05)。C组患者T2、T3时t-PA、PAI-1的水平均高于T1时,差异均有统计学意义(t分别=5.77、4.23、15.04、5.42,P均<0.05)。而A组、B组不同时间点APTT、PT、FIB、TT水平和t-PA、PAI-1水平比较,差异均无统计学意义(F分别=0.75、1.02、0.84、0.91、1.04、0.62,P均>0.05)。C组患者的肠鸣音出现时间、排气时间、进食时间均长于A组和B组,B组长于A组,差异均有统计学意义(t分别=17.72、6.33、11.25、27.80、10.51、25.22、11.50、9.74、10.51,P均<0.05)。结论腹腔镜胆囊切除术中气腹压力在7~10 mmHg范围内升高,患者的凝血纤溶功能不会发生改变,当增加至13 mmHg时可刺激机体高凝状态并抑制纤溶功能、损伤胃肠功能。Objective To investigate the influence of CO2 pneumoperitoneal pressure on coagulation,fibrinolysis and recovery of gastrointestinal function in patients undergoing laparoscopic cholecystectomy.Methods Totally 180 cases of chronic cholecystitis patients underwent laparoscopic cholecystectomy were included and randomly divided into three group,group A(CO2 pneumoperitoneal pressure was 7 mmHg),group B(CO2 pneumoperitoneal pressure was 10 mmHg)and group C(CO2 pneumoperitoneal pressure was 13 mmHg),with 60 cases in each.The thromboplastin time(APTT),prothrombin time(PT),fibrinogen(FIB),thrombin time(TT),plasminogen activator(t-PA),plasminogen activator inhibitor-1(PAI-1),recovery of gastrointestinal function and occurrence of complications were compared among three groups at times of before establishment of pneumoperitoneum(T1),30 minutes after establishment of pneumoperitoneum(T2),and24 hours after operation(T3).Results The levels of APTT,PT and TT in group C at T2 and T3 were lower than those at T1,while the levels of FIB,t-PA and PAI-1 were higher(t=2.97,2.41,3.65,4.70,3.46,4.94,5.30,7.30,5.77,4.23,15.04,5.42,P<0.05).There was no significant difference in APTT,PT,FIB,TT,t-PA,PAI-1 levels between group A and group B at different points(F=0.75,1.02,0.84,0.91,1.04,0.62,P>0.05).The occurrence time,exhaust time and eating time of group C were longer than those of group A and group B,and those parameters of group B were longer than the group A,the differences were statistically significant(t=17.72,6.33,11.25,27.80,10.51,25.22,11.50,9.74,10.51,P<0.05).Conclusion In laparoscopic cholecystectomy,the coagulation and fibrinolysis function of patients will not change,which based on the pneumoperitoneal pressure at a certain range(7~10 mmHg).Excessive increased CO2 pneumoperitoneal pressure to 13 mmHg would stimulate hypercoagulability,inhibit fibrinolysis and damage gastrointestinal function.

关 键 词：腹腔镜胆囊切除术 CO2气腹压力 凝血功能 纤溶功能 胃肠功能 

分 类 号：R657.4[医药卫生—外科学]