体温保护对手术患者凝血功能及乳酸的影响  

Effect of body temperature protection on coagulation and lactate function in patients undergoing operation

作　　者：刘宇权 肖卓辉 陈燕中 曾志文[1] 廖亿粦[1] 肖胜兵[1] LIU Yu-quan;XIAO Zhuo-hui;CHEN Yan-zhong(Department of Anesthesiology,Meizhou People's Hospital,Meizhou Guangdong 514031,China)

机构地区：[1]梅州市人民医院麻醉科,广东梅州514031

出　　处：《临床和实验医学杂志》2020年第19期2116-2120,共5页Journal of Clinical and Experimental Medicine

基　　金：广东省医学科研基金项目(编号:A2015511);梅州市社会发展科技计划项目(编号:2017B003)。

摘　　要：目的探讨体温保护对腹腔镜肝叶切除术患者凝血功能及乳酸的影响。方法前瞻性选择2017年2月至2019年10月梅州市人民医院腹腔镜肝叶切除术患者90例,随机分为观察组(术中体温保护,n=45)和对照组(术中一般护理,n=45);监测患者术中各个时间点鼻咽温、血压水平,获取手术情况(手术时间、术中出血量)、凝血功能[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)、纤维蛋白原(FIB)、血小板(PLT)]、乳酸、肝功能指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、谷氨酞转肽酶(GGT)]。结果两组手术时间、术中出血量、肝功能指标及各时间点鼻咽温、血压变化差异无统计学意义(P>0.05)。观察组术后PT、PLT值低于对照组,而INR高于对照组(P<0.05)。观察组和对照组术后APTT、FIB、ALT、AST、GGT值比较差异均无统计学意义(P>0.05)。观察组切肝前、切肝后、手术结束时血乳酸酸值差异均无统计学意义(P>0.05);随着手术进展,对照组血乳酸值依次升高(P<0.05);观察组麻醉后各时期血乳酸值低于对照组(P<0.05)。结论体温保护可维持腹腔镜肝叶切除术患者基本生命体征,对机体凝血功能、肝功能、乳酸值无显著影响,为临床治疗和术后恢复创造良好的支持条件。Objective To investigate the effect of body temperature protection on coagulation and lactate function in patients undergoing laparoscopic hepatolobectomy.Methods 90 patients with underwent laparoscopic hepatolobectomy in No.1,Meizhou People's Hospital from February 2017 to October 2019 were forward looking enrolled,and randomly divided into two groups,each with 45 cases.Observation group received body temperature protection during operation,while control group received the routine nursing.Then various indexes were recorded,including pharyngonasal temperature,blood pressure,operation time,intraoperative blood loss,prothrombin time(PT),activated partial thromboplastin time(APTT),international normalizedratio(INR),fibrinogen(FIB),plate(PLT),lactate function,alanine aminotransferase(ALT),aspartate aminotransferase(AST),and gamma-glutamyltranspeptidase(GGT).Results The operation time,intraoperative blood loss,liver function indexes,pharyngonasal temperature and blood pressure had no significant changes at each time points(P>0.05).After operation,observation group had lower PT and PLT as well as higher INR levels than those of control group(P<0.05).There was no significant difference in APTT,FIB,ALT,AST,GGT values between the observation group and the control group after operation(P>0.05).The blood lactic acid value at the time points of before hepatectomy,after hepatectomy and at the end of operation in observation group were no difference(P>0.05).With the progress of operation,the blood lactic acid value was gradually increased in control group(P<0.05).The blood lactic acid value of observation group was lower than that of control group at each time points after anesthesia(P<0.05).Conclusion Body temperature protection can maintain basic vital signs of patients with laparoscopic hepatolobectomy,has no significant effect on the body's coagulation function,liver function,lactic acid value,and provide support for clinical treatment and postoperative recovery.

关 键 词：肝切除手术 体温保护 凝血功能 乳酸 

分 类 号：R657.3[医药卫生—外科学]