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二氧化碳气腹时间对腹腔镜胆囊切除术患者血液流变学的影响 被引量:6

Effect of Duration of Pneumoperitoneum on Hemorheology in Patients Undergoing Laparoscopic Cholecystectomy.
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摘要 目的观察C02气腹时间对腹腔镜胆囊切除术(1aparoscopic cholecystectomy,LC)患者血液流变学的影响。方法胆石症择期行LC患者64例,年龄〈60岁,术后根据CO2气腹持续时间归组:A组(21例):气腹时间≤30min;B组(23例):气腹时间30~60min;C组(20例):气腹时间≥61min。于入院检查时(基础值)、术毕、术后1天、2天及3天抽取静脉血检测血液流变学指标、血小板计数(PLT)、血细胞比容(Hct)、纤维蛋白原浓度(Fib)、D-二聚体(D—D)。结果各组血浆和全血黏度、Fib于术毕均低于基础值(P〈0.05),A组术后的全血和血浆黏度、红细胞聚集指数、Fib及D—D无明显变化;B组术后1天、2天的D—D高于基础值(P〈0.05);C组术后1天的血浆黏度、红细胞聚集指数高于基础值(P〈0.05),术后2天和3天的Fib及D—D高于基础值(P〈0.05)。c组的血浆黏度于术后1天高于A组,Fib及D—D于术后2天和3天高于A组,术后3天的D—D高于B组(P〈0.05)。A、B两组间各指标无明显差异。结论全身情况良好的LC手术患者,手术时间短时,血液流变学指标变化不明显;而随手术时间延长,术后Fib和D-二聚体明显增高,全血和血浆黏度增加,提示静脉血栓发生的风险增加。 Objective To observe the effect of duration of pneumoperitoneum on hemorheology in patients undergoing laparoscopie cholecystectomy(LC). Methods Sixty- four patients with cholelithiasis scheduled for LC without systematic disease,aged 〈 60 yeas, were placed in different groups respeetively after surgery according to the duration of pneumoperitoneum. In group A (21 cases) , duration of pneumoperitoneum was ≤ 30min ;in group B (23 cases) , duration of pneumoperitoneum was 30 - 60rain and in group C (20 cases) , duration of pneumoperitoneum was ≥ 61min. Venous blood samples were taken at examination on admission (baseline) , at the end of surger- y, postoperative 1 d, 2d and 3d for determination of hemorheology, blood platelet count (PLT) , hematoerit (Her) , prothrombin time (PT) , activated partial thromboplastin time(APTT) ,fibrinogen (Fib),D -dimer( D -D). Results No significant difference was found in the baseline values of each parameter among the three groups. Compared with baseline values, plasma and whole blood viscosity were de- creased in the three groups at the end of surgery ( P 〈 0.05 ) , and there was no significant difference in p]asma and whole blood viscosity, erythroeyte aggregation index,Fib and D -D after surgery in group A. There was significant increase in D -D 2d postoperation in group B compared with baseline values (P 〈 0. 05 ). Plasma viscosity and erythrocyte aggregation index on 1 d, Fib and D - D on 2d and 3d postop- eration increased significantly in group C compared with baseline values. In group C, plasma viscosity on ld, Fib and D - D on 2d and 3d postoperation were higer than those in group A ( P 〈 0.05 ) , D - D on 3d postoperation was higer than that in group B ( P 〈 0. 05 ). There was no significant difference in parameters of hemorheology between group A and B. Conclusion Postoperative hemorheology didn't change pronouncedly when with short duration of pneumoperitoneum in patients undergoing LC. While Fib, DD, whole blood and plasma viscosity postoperation significantly increased along with prolonged duration of pneumoperitoneum, which increased the risk of venous thrombosis probably.
出处 《医学研究杂志》 2011年第6期56-60,共5页 Journal of Medical Research
基金 浙江省卫生厅自然科学基金资助项目(2009A022)
关键词 腹腔镜胆囊切除 气腹 血液流变学 Laparoseopie cholecysteetomy Pneumoperitoneum Hemorheology
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