CAJ | 학술논문

目的比较不同二氧化碳气腹时间胆囊切除术患者的凝血纤溶功能和血管内膜损伤程度.方法择期拟行腹腔镜胆囊切除术患者64例,年龄23～60岁,体重45～82 kg,ASA分级Ⅰ或Ⅱ级,根据气腹持续时间不同分为3组:气腹时间≤30 min组(Ⅰ组,n=21)、30 min＜气腹时间＜60 min组(Ⅱ组,n=23)和气腹时间≥60 min组(Ⅲ组,n=20).气腹压力维持12～14 mm Hg,分别于术前(T0)、术毕(T1)、术后1、2,3 d(T2～4)时抽取静脉血样,测定凝血酶原时间、激活部分凝血活酶时间、血浆凝血酶原片段1+2(F1+2)、纤维蛋白原(Fib)、组织纤溶酶原激活物和纤溶酶原激活物抑制物-1(PAI-1)的浓度和抗凝血酶-Ⅲ(AT-Ⅲ)、血管性血友病因子(vWF)的活性.结果与Ⅰ组比较,Ⅲ组T2时vWF活性和PAI-1浓度升高,T3时Fjb、F1+2、PAI-1浓度和vWF活性升高,AT-Ⅲ活性降低,T4时Fib 和F1+2浓度升高(P＜0.05);与Ⅱ组比较,Ⅲ组上述指标差异无统计学意义(P＞0.05).结论气腹时间短时胆囊切除术后患者凝血纤溶功能变化小,血管内膜损伤不明显;随气腹时间延长,凝血功能增强,纤溶功能受抑制,血管内膜损伤加重.
목적 비교불동이양화탄기복시간담낭절제술환자적응혈섬용공능화혈관내막손상정도.방법 택기의행복강경담낭절제술환자64례,년령23～60세,체중45～82 kg,ASA분급Ⅰ혹Ⅱ급,근거기복지속시간불동분위3조:기복시간≤30 min조(Ⅰ조,n=21)、30 min＜기복시간＜60 min조(Ⅱ조,n=23)화기복시간≥60 min조(Ⅲ조,n=20).기복압력유지12～14 mm Hg,분별우술전(T0)、술필(T1)、술후1、2,3 d(T2～4)시추취정맥혈양,측정응혈매원시간、격활부분응혈활매시간、혈장응혈매원편단1+2(F1+2)、섬유단백원(Fib)、조직섬용매원격활물화섬용매원격활물억제물-1(PAI-1)적농도화항응혈매-Ⅲ(AT-Ⅲ)、혈관성혈우병인자(vWF)적활성.결과 여Ⅰ조비교,Ⅲ조T2시vWF활성화PAI-1농도승고,T3시Fjb、F1+2、PAI-1농도화vWF활성승고,AT-Ⅲ활성강저,T4시Fib 화F1+2농도승고(P＜0.05);여Ⅱ조비교,Ⅲ조상술지표차이무통계학의의(P＞0.05).결론 기복시간단시담낭절제술후환자응혈섬용공능변화소,혈관내막손상불명현;수기복시간연장,응혈공능증강,섬용공능수억제,혈관내막손상가중.
Objective To compare the changes in blood coagulation, fibrinolysis and endothelial damage in patients undergoing laparoscopic cholecystectomy with different durations of carbon dioxide pneumoperitoneum. Methods Sixty-four ASA Ⅰ orⅡpatients, aged 23-60 yr, weighing 45-82 kg, scheduled for elective laparoscopic cholecystectomy, were randomly divided into 3 groups according to the duration of pneumoperitoneum: duration of pneumoperitoneum ≤30 min group (group Ⅰ, n=21), 30 min ＜ duration of pneumoperitoneum ＜ 60 min (group Ⅱ, n=23) and duration of pneumoperitoneum≥ 60 min (group Ⅲ , n=20).The intra-abdominal pressure was maintained at 12-14 mm Hg. Venous blood samples were taken before surgery (baseline, T0 ),at the end of surgery(T1), and at 1, 2 and 3 d after surgery (T2-4) for determination of prothrombin time, activated partial thromboplastin time, concentrations of prothrombin fragment 1+2(F1+2), fibrinogen (Fib), tissue plasminogen activator and plasminogen activator inhibitor type-1 (PAI-1), and activities of antithrombin Ⅲ(AT-Ⅲ)and von Willebrand factor(vWF).Results Compared with groupⅠ , the vWF activity and PAI-1 concentration at T2 , concentrations of Fib, F1+2, PAI-1 and activity of vWF at T3 and concentrations of Fib and F1+2 at T4 were significantly increased, while the AT-IE activity at T3 was significantly decreased in group Ⅲ(P＜0.05) .Conclusion When the duration of pneumoperitoneum is short, no obvious changes in the blood coagulation, fibrinolysis and endothelial damage are observed postoperatively in patients undergoing laparoscopic cholecystectomy, and along with the prolongation of the duration of pneumoperitoneum, increased blood coagulation, reduced fibrinolysisand aggravated endothelial damage are observed postoperatively.