不同气腹模式对腹腔镜结直肠癌手术患者下肢深静脉血流速度的影响  

Impact of Different Pneumoperitoneum Modes on Blood Flow Velocity in Deep Veins of Lower Extremities in Patients Undergoing Laparoscopic Colorectal Surgery

作　　者：孙惠华[1] 田秋菊 吴蓓雯[1] SUN Huihua;TIAN Qiuju;WU Beiwen(Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200025)

机构地区：[1]上海交通大学医学院附属瑞金医院,上海200025

出　　处：《上海护理》2025年第2期24-29,共6页Shanghai Nursing

摘　　要：目的探讨CO_(2)气腹模式对腹腔镜结直肠癌手术患者下肢深静脉血流速度的影响。方法采用便利抽样法选取2020年6月至2023年2月于上海某三级综合性医院接受腹腔镜全系膜切除术的结直肠癌患者606例为研究对象,根据使用的气腹模式分为传统气腹组(对照组,n=490)和稳压气腹组(观察组,n=116),通过倾向性评分匹配选出其中222例作为研究对象,两组各111例。观察2组患者气腹60 min及气腹结束后下肢深静脉血流速度变化、术前术后凝血功能指标及深静脉血栓发生情况,并进行比较。结果在气腹60 min及气腹结束后,观察组患者收缩期静脉血流峰速度(PSV)及舒张期静脉血流速度(EDV)的变化均小于对照组,差异有统计学意义(P<0.05);2组患者的凝血系统均明显被激活,术后活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)均缩短,D-二聚体水平升高(P<0.001),但组间差异无统计学意义(P>0.05);2组患者术后深静脉血栓发生率比较,差异无统计学意义(P>0.05)。结论CO_(2)气腹可致腹腔镜结直肠癌手术患者下肢深静脉血流速度下降,稳压气腹组较传统气腹组对患者血流速度的影响小,在临床工作中可参考使用稳压气腹模式。Objective To investigate the impact of different CO_(2) pneumoperitoneum modes on blood flow velocity in deep veins of lower extremities in patients undergoing laparoscopic colorectal surgery.Methods A total of 606 colorectal cancer patients who underwent laparoscopic total mesorectal excision at a tertiary general hospital in Shanghai from June 2020 to February 2023 were selected by convenience sampling.They were divided into the traditional pneumoperitoneum group(control group,n=490)and the stable-pressure pneumoperitoneum group(observation group,n=116)based on pneumoperitoneum mode;222 of them were further selected by propensity score matching(n=111 in each group).The changes in blood flow velocity in deep veins of lower extremities at 60 min and after pneumoperitoneum,coagulation function indicators before and after survey and incidence of deep vein thrombosis were observed and compared between the two groups.Results At 60 min and after pneumoperitoneum,the changes in peak systolic velocity(PSV)and end-diastolic velocity(EDV)in the observation group were smaller than those in the control group,with significant differences(P<0.05);the coagulation system was significantly activated in both groups,as evidenced by shortened activated partial thromboplastin time(APTT),shortened prothrombin time(PT)and elevated D-dimer level after the surgery(P<0.001),without significant difference between groups(P>0.05);the incidence of postoperative deep vein thrombosis was not significantly different between groups(P>0.05).Conclusion CO_(2) pneumoperitoneum can reduce the blood flow velocity in deep veins of lower extremities in patients undergoing laparoscopic colorectal cancer surgery.In clinical practice,stable-pressure pneumoperitoneum may be preferable as it has less impact on blood flow velocity than traditional pneumoperitoneum.

关 键 词：结直肠癌CO_(2)气腹 腹腔镜手术 血流速度 深静脉血栓 

分 类 号：R473.73[医药卫生—护理学]