高血压病患者腹腔镜气腹后凝血标志物的变化

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。

Changes of the coagulation markers in essential hypertension patients un-dergoing laparoscopic pneumoperitoneum

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.