腹腔镜手术对腹部手术患者围术期应激及凝血功能的影响
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摘要
目的探讨腹腔镜手术对腹部手术患者围术期应激及凝血功能的影响。方法选取我院2014年9月-2016年1月期间在我院择期行腹部手术的患者98例,随机分为观察组和对照组,每组49例,观察组行腹腔镜手术,对照组行常规开腹手术;比较两组围术期应激指标平均动脉压(MAP)、心率(HR)、血清去甲肾上腺素(NE)、皮质醇(Cor)浓度,比较两组围术期凝血功能指标凝血酶原时间(PT)、活化部分凝血活酶时间(aPTT)、凝血酶时间(TT),并观察两组术后血栓等不良事件发生情况。结果两组患者在气管插管时至拔管即刻MAP、HR、NE、Cor均有所升高,尤其MAP、NE、Cor在术毕、拔管即刻较气管插管时升高显著(P<0.05);观察组在气管插管时至拔管即刻各时点MAP、HR、NE、Cor显著较低(P<0.05);对照组PT、aPTT、TT值各时点均高于正常值,观察组仅PT在手术30 min、aPTT和TT值术毕高于正常值,两组PT、aPTT、TT在手术30 min、术毕及术后24 h比较,差异有统计学意义(P<0.01);观察组血栓发生率4%明显低于对照组12%(P<0.05)。结论腹腔镜辅助下行腹部手术有利于减轻患者围术期应激反应,减少凝血功能的负面影响,降低术后血栓等不良事件发生风险,对腹部手术患者围术期应激及凝血功能的改善有重要意义。
Objective To explore effects of laparoscopic surgery on perioperative stress and coagulation function in patients undergoing abdominal operation. Methods 98 patients who received selective abdominal operation in our hospital from September 2014 to January 2016 were selected,they were randomly divided into the observation group and the control group( each 49 cases),the observation group received laparoscopic surgery,the control group received conventional open surgery; perioperative stress indexes mean arterial pressure( MAP),heart rate( HR),serum norepinephrine( NE),cortisol( Cor) potency in the two groups were compared,perioperative coagulation function indexes prothrombin time( PT),activated partial thromboplastin time( aPTT),thrombin time( TT) in the two groups were compared,postoperative thrombus and other adverse events in the two groups were observed. Results MAP,HR,NE,Cor from endotracheal intubation to tube drawing in the two groups were increased,especially MAP,NE,Cor at the end of operation,tube drawing were significantly increased compared with endotracheal intubation( P < 0. 05); MAP,HR,NE,Cor from endotracheal intubation to tube drawing in the observation group were significantly lower( P < 0. 05); PT,aPTT,TT value in the control group at different time were higher than normal value,only PT at 30 min of operation,aPTT and TT value at the end of operation in the observation group were higher than normal value,there was a significant difference in PT,aPTT,TT at 30 min of operation,at the end of operation,postoperative 24 h in the two groups( P < 0. 01); incidence of thrombus in the observation group 4% were significantly lower than the control group( 12%)( P < 0. 05). Conclusion Laparoscopy- assisted abdominal operation is beneficial to reduce perioperative stress response,reduce negative effect of coagulation function,reduce postoperative thrombus and other adverse events risk,is significant to improvement of perioperative stress and coagulation function of patients who received abdominal operation.
Objective To explore effects of laparoscopic surgery on perioperative stress and coagulation function in patients undergoing abdominal operation. Methods 98 patients who received selective abdominal operation in our hospital from September 2014 to January 2016 were selected,they were randomly divided into the observation group and the control group( each 49 cases),the observation group received laparoscopic surgery,the control group received conventional open surgery; perioperative stress indexes mean arterial pressure( MAP),heart rate( HR),serum norepinephrine( NE),cortisol( Cor) potency in the two groups were compared,perioperative coagulation function indexes prothrombin time( PT),activated partial thromboplastin time( aPTT),thrombin time( TT) in the two groups were compared,postoperative thrombus and other adverse events in the two groups were observed. Results MAP,HR,NE,Cor from endotracheal intubation to tube drawing in the two groups were increased,especially MAP,NE,Cor at the end of operation,tube drawing were significantly increased compared with endotracheal intubation( P < 0. 05); MAP,HR,NE,Cor from endotracheal intubation to tube drawing in the observation group were significantly lower( P < 0. 05); PT,aPTT,TT value in the control group at different time were higher than normal value,only PT at 30 min of operation,aPTT and TT value at the end of operation in the observation group were higher than normal value,there was a significant difference in PT,aPTT,TT at 30 min of operation,at the end of operation,postoperative 24 h in the two groups( P < 0. 01); incidence of thrombus in the observation group 4% were significantly lower than the control group( 12%)( P < 0. 05). Conclusion Laparoscopy- assisted abdominal operation is beneficial to reduce perioperative stress response,reduce negative effect of coagulation function,reduce postoperative thrombus and other adverse events risk,is significant to improvement of perioperative stress and coagulation function of patients who received abdominal operation.
引文
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