临床研究(Clinical Research)

腹腔镜胆囊切除术后患者血液高凝状态形成影响因素的前瞻性队列研究

Published at: 2017年第26卷第8期

曹波 1 , 王锦江 2
1 延安大学附属医院 普通外科,陕西 延安 716000
2 陕西省延安市人民医院 普通外科,陕西 延安 716000
通讯作者 锦江 王 Email: sxyawjinjiang@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.08.012
基金:
陕西省教育厅自然科学研究基金资助项目 09JK819

摘要

目的:探讨影响腹腔镜胆囊切除术后患者血液高凝状态形成的影响因素。方法:前瞻性选择2012年1月—2015年12月接受腹腔镜胆囊切除术治疗的患者108例为研究对象,比较术后24 h发生血液高凝状态与未发生血液高凝状态的患者间相关临床因素的差异,分析术后血液高凝状态形成的影响因素。结果:108例腹腔镜胆囊切除术患者中,32例(29.63%)发生血液高凝状态。与未发生血液高凝状态的患者比较,发生血液高凝状态的患者有高血脂病史的比例与术前收缩压、纤维蛋白原(Fbg)、D-二聚体(D-D)、血小板计数(PLT)、凝血酶原片段(F1+F2)、转铁蛋白(Trf)、α-酸性糖蛋白(Orso)、C-反应蛋白(CRP)、白介素6(IL-6)、低密度脂蛋白胆固醇(LDL-C)水平明显增高,而高密度脂蛋白胆固醇(HDL-C)水平明显降低(均P<0.05)。单因素与多因素Logistic回归分析结果显示,有高血脂病史、Fbg≥3.95 g/L、D-D≥100.00 µg/L、PLT≥228.00×109/L、F1+F2≥0.16 nmol/L、Trf≥2.15 g/L、Orso≥0.85 g/L、CRP≥1.50 mg/L、IL-6≥1.50 pg/mL、LDL-C≥2.85 mg/dL是腹腔镜胆囊切除术后患者血液高凝状态形成的独立危险性因素(均P<0.05)。结论:对于行腹腔镜胆囊切除术患者,如存在上述因素应注意血液高凝状态的发生。


Factors for hypercoagulable state formation after laparoscopic cholecystectomy: a prospective cohort study

Abstract

Objective: To investigate the influential factors for hypercoagulable state formation in patients after laparoscopic cholecystectomy. Methods: One hundred and eight patients undergoing laparoscopic cholecystectomy from January 2012 to December 2015 were prospectively selected as study subjects. The differences in the relevant clinical variables were compared between patients with and without hypercoagulable state formation, and the factors for postoperative hypercoagulable state formation were analyzed. Results: Of the 108 patients undergoing laparoscopic cholecystectomy, 32 cases (29.63%) were found having a hypercoagulable state. In patients with hypercoagulable state compared with those without hypercoagulable state, the proportion of cases with hyperlipidemia history and preoperative levels of systolic blood pressure, fibrinogen (Fbg), D-dimer (D-D), platelet count (PLT), prothrombin fragments (F1+F2), transferrin (Trf), alpha acid glycoprotein (Orso), C-reactive protein (CRP), interleukin 6 (IL-6), and low density lipoprotein cholesterol (LDL-C) were significantly increased, while the high density lipoprotein cholesterol (HDL-C) level was significantly decreased (all P<0.05). Univariate and multivariate Logistic regression analyses showed that hyperlipidemia history, Fbg≥3.95g/L, D-D≥100.00 µg/L, PLT≥228.00×109/L, F1+F2≥0.16 nmol/L, Trf≥2.15 g/L, Orso≥0.85 g/L, CRP≥1.50 mg/L, IL-6≥1.50 pg/mL, LDL-C≥2.85 mg/dL were independent risk factors for hypercoagulable state formation after laparoscopic cholecystectomy (all P<0.05). Conclusion: For patients undergoing laparoscopic cholecystectomy, attention should be paid to the occurrence of hypercoagulable state formation in those with above risk factors.


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引用

引用本文: 波 曹, 锦江 王. 腹腔镜胆囊切除术后患者血液高凝状态形成影响因素的前瞻性队列研究[J]. 中国普通外科杂志, 2017, 26(8): 1036-1041.
Cite this article as: CAO Bo, WANG Jinjiang . Factors for hypercoagulable state formation after laparoscopic cholecystectomy: a prospective cohort study [J]. Chin J Gen Surg, 2017, 26(8): 1036-1041.