腹腔镜袖状胃切除术后患者血液高凝状态形成的影响因素分析  

Influencing factors of the formation of blood hypercoagulability in the patients after laparoscopic sleeve gastrectomy

作　　者：纪澄华 李凤慧[2] 李晓川[3] JI Cheng-hua;LI Feng-hui;LI Xiao-chuan(Outpatient Service Center,Municipal Hospital of Qingdao City,Qingdao 266001,China;Department of Vascular Surgery,Municipal Hospital of Qingdao City,Qingdao 266001,China;Department of General Surgery,Municipal Hospital of Qingdao City,Qingdao 266001,China)

机构地区：[1]山东省青岛市市立医院门诊病人服务中心,山东青岛266001 [2]山东省青岛市市立医院血管外科,山东青岛266001 [3]山东省青岛市市立医院普外科,山东青岛266001

出　　处：《中国现代普通外科进展》2023年第4期292-296,共5页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探讨肥胖患者腹腔镜袖状胃切除术后血液高凝状态形成的影响因素。方法:选择2017年1月至2021年1月青岛市市立医院接受腹腔镜袖状胃切除术(LSG)的92例肥胖患者,根据术后是否出现血液高凝分为高凝组和非高凝组,比较两组患者性别、年龄、体质量指数(BMI)、高血压史、高脂血症史、糖尿病史、术前收缩压及舒张压,术前3 d内的白细胞(WBC)、红细胞(RBC)、红细胞压积(HCT)、血小板(PLT)、血小板压积(PCT)、空腹血糖(GLU)、胆固醇(CHOL)、甘油三酯(TRIG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、钙离子(Ca^(2+))、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(FIB),手术时间、术中输液量、术中出血量、术中尿量等。对两组间有统计学差异的因素进行多因素Logistic回归分析。结果:92例LSG患者均未见血栓形成,其中41例(44.57%)发生血液高凝状态,51例(55.43%)未出现血液高凝状态。两组性别、年龄、高血脂病史、PLT、PCT、HDL-C、TRIG及APTT比较,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,术前高脂血症史、年龄及APTT是LSG术后血液高凝状态的独立影响因素(均P<0.05)。结论:对于LSG患者,高脂血症史和年龄为危险因素,APTT为保护因素。如患者有高脂血症史或年龄较大应注意预防术后血液高凝状态。Objective:To investigate the influencing factors of blood hypercoagulability in obese patients after laparoscopic sleeve gastrectomy.Methods:From January 2017 to January 2021,obese patients undergoing laparoscopic sleeve gastrectomy(LSG)under general anesthesia in Municipal Hospital of Qingdao City were operated by the same chief physician.The patients were divided into hypercoagulable group and non hypercoagulable group according to whether there was hypercoagulable blood after operation.The general clinical data(gender,age,body mass index(BMI),history of hypertension,hyperlipidemia,diabetes,preoperative systolic and diastolic blood pressure),white blood cell(WBC),red blood cell(RBC),hematocrit(HCT),platelet(PLT)within 3 days before operation were analyzed Hematocrit(PCT),fasting blood glucose(Glu),cholesterol(Chol),triglyceride(trig),high density lipoprotein(HDL-C),low density lipoprotein(LDL-C),calcium ion(Ca^(2+)),prothrombin time(PT),partial thromboplastin time(APTT),fibrinogen(FIB);The operation time,intraoperative infusion volume,intraoperative blood loss and intraoperative urine volume were compared.Then the factors with statistical difference between the two groups were analyzed by multivariate logistic regression to find out the factors influencing the formation of postoperative hypercoagulable state.Results:No thrombosis was found in 92 patients undergoing laparoscopic sleeve gastrectomy.Among them,41 cases(44.57%)had hypercoagulable state,and 51 cases(55.43%)had no hypercoagulable state.Compared with the non hypercoagulable group,the age,history of hyperlipidemia,PLT,PCT and HDL-C in the hypercoagulable group were significantly higher than those in the non hypercoagulable group,and the male ratio,triglyceride(trig)and partial thromboplastin time(APTT)in the hypercoagulable group were significantly lower than those in the non hypercoagulable group(all P<0.05).Multivariate logistic regression analysis showed that only preoperative history of hyperlipidemia,age and partial thromboplastin time(APTT)were t

关 键 词：胃切除术 腹腔镜 肥胖 高凝状态 影响因素 

分 类 号：R656.61[医药卫生—外科学]