中国医药导报
中國醫藥導報
중국의약도보
CHINA MEDICAL HERALD
2014年
35期
45-49
,共5页
凝血%纤维蛋白溶解%腹腔镜胆囊切除术%气腹%高凝状态%高血压病
凝血%纖維蛋白溶解%腹腔鏡膽囊切除術%氣腹%高凝狀態%高血壓病
응혈%섬유단백용해%복강경담낭절제술%기복%고응상태%고혈압병
Coagulation%Fibrinolysis%Laparoscopic cholecystectomy%Pneumoperitoneum%Hypercoagula-ble state%Hypertension
目的：探讨腹腔镜胆囊切除术术中气腹对高血压病患者凝血-纤溶系统的影响。方法选择首都医科大学附属北京同仁医院择期行腹腔镜胆囊切除术的96例患者，根据原发性高血压病的诊断标准和患者的既往病史，分为高血压病组25例、非高血压病组31例和对照组40例。分别采集患者气腹前后的血样标本，测定血浆组织型纤溶酶原激活物(t-PA)、凝血酶-抗凝血酶Ⅲ复合物(TAT)、组织因子活性(TF：A)和纤溶酶原激活物抑制物(PAI-1)四种凝血分子标志物的情况。结果①气腹前高血压病组TAT、PAI-1、t-PA高于非高血压病组和对照组，差异均有高度统计学意义(P<0.01)。②气腹后，高血压病组TAT、PAI-1较气腹前增高，差异均有高度统计学意义(P<0.01)；非高血压病组TAT、PAI-1、t-PA均较气腹前增高，差异均有统计学意义(P<0.05)。③气腹后血浆凝血分子标志物变化程度的比较：高血压病组驻TAT、驻PAI-1与非高血压病组比较，差异均有统计学意义(P<0.05或P<0.01)；非高血压病组驻t-PA与高血压病组比较，差异均有统计学意义(P<0.05)。结论腹腔镜胆囊切除术中的气腹过程使高血压病患者的凝血功能增强而纤溶功能受抑制，增加了术后血栓形成的风险，因此术前应使用抗凝药物防治术后静脉血栓形成。
目的：探討腹腔鏡膽囊切除術術中氣腹對高血壓病患者凝血-纖溶繫統的影響。方法選擇首都醫科大學附屬北京同仁醫院擇期行腹腔鏡膽囊切除術的96例患者，根據原髮性高血壓病的診斷標準和患者的既往病史，分為高血壓病組25例、非高血壓病組31例和對照組40例。分彆採集患者氣腹前後的血樣標本，測定血漿組織型纖溶酶原激活物(t-PA)、凝血酶-抗凝血酶Ⅲ複閤物(TAT)、組織因子活性(TF：A)和纖溶酶原激活物抑製物(PAI-1)四種凝血分子標誌物的情況。結果①氣腹前高血壓病組TAT、PAI-1、t-PA高于非高血壓病組和對照組，差異均有高度統計學意義(P<0.01)。②氣腹後，高血壓病組TAT、PAI-1較氣腹前增高，差異均有高度統計學意義(P<0.01)；非高血壓病組TAT、PAI-1、t-PA均較氣腹前增高，差異均有統計學意義(P<0.05)。③氣腹後血漿凝血分子標誌物變化程度的比較：高血壓病組駐TAT、駐PAI-1與非高血壓病組比較，差異均有統計學意義(P<0.05或P<0.01)；非高血壓病組駐t-PA與高血壓病組比較，差異均有統計學意義(P<0.05)。結論腹腔鏡膽囊切除術中的氣腹過程使高血壓病患者的凝血功能增彊而纖溶功能受抑製，增加瞭術後血栓形成的風險，因此術前應使用抗凝藥物防治術後靜脈血栓形成。
목적：탐토복강경담낭절제술술중기복대고혈압병환자응혈-섬용계통적영향。방법선택수도의과대학부속북경동인의원택기행복강경담낭절제술적96례환자，근거원발성고혈압병적진단표준화환자적기왕병사，분위고혈압병조25례、비고혈압병조31례화대조조40례。분별채집환자기복전후적혈양표본，측정혈장조직형섬용매원격활물(t-PA)、응혈매-항응혈매Ⅲ복합물(TAT)、조직인자활성(TF：A)화섬용매원격활물억제물(PAI-1)사충응혈분자표지물적정황。결과①기복전고혈압병조TAT、PAI-1、t-PA고우비고혈압병조화대조조，차이균유고도통계학의의(P<0.01)。②기복후，고혈압병조TAT、PAI-1교기복전증고，차이균유고도통계학의의(P<0.01)；비고혈압병조TAT、PAI-1、t-PA균교기복전증고，차이균유통계학의의(P<0.05)。③기복후혈장응혈분자표지물변화정도적비교：고혈압병조주TAT、주PAI-1여비고혈압병조비교，차이균유통계학의의(P<0.05혹P<0.01)；비고혈압병조주t-PA여고혈압병조비교，차이균유통계학의의(P<0.05)。결론복강경담낭절제술중적기복과정사고혈압병환자적응혈공능증강이섬용공능수억제，증가료술후혈전형성적풍험，인차술전응사용항응약물방치술후정맥혈전형성。
Objective To investigate the influence of pneumoperitoneum on the coagulation and fibrinolysis in patients with essential hypertension during laparoscopic cholecystectomy (LC). Methods According to the diagnostic criteria of essential hypertention, the 96 patients who had undergone LC in Beijing Tongren Hospital Affiliated to Capital Medical University were divided into three groups: essential hypertension group (25 cases), non-essential hypertension group (31 cases) and control group (40 cases). Blood samples of the patients were collected before and after pneumoperi-toneum. The following plasma molecular markers were mensurated:tissue-type plasminogen activator (t-PA), thrombin-antithrombinⅢ complexes (TAT), tissue factor activity (TF: A) and plasminogen activator inhibitor-1 (PAI-1). Results①Pre-pneumoperitoneum: TAT, PAI-1 and t-PA in essential hypertension group were significantly increased com-pared with the other two groups, the differences were statistically significant (P < 0.01). ②Post-pneumoperitoneum:TAT and PAI-1 in essential hypertension group were significantly increased, the differences were statistically signifi-cant (P<0.01); TAT, PAI-1 and t-PA in non-essential hypertension group were increased statistically, the differences were statistically significant (P < 0.05). ③Post-pneumoperitoneum: The increasement of TAT and PAI-1 were more significant in essential hypertension group, the differences were statistically significant (P<0.05 or P<0.01). The in-creasement of t-PA was more significant in non-essential hypertension group, the difference was statistically significant (P<0.05). Conclusion The pneumoperitoneum during LC increases the risk of thromboembolism, since the coagulation activity increases and the fibrinolytic activity decreases in the operation. The essential hypertension patients should use anticoagulation drugs in order to prevent postoperation thrombosis.
