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目的研究腹腔镜胆囊切除术对合并高脂血症患者手术前后凝血、纤溶功能的影响。方法将60例行腹腔镜胆囊切除术的病人分为非高脂血症组和高脂血症组,分别在全麻诱导后气腹前及手术结束时抽取足背静脉血测定血栓调节蛋白(TM)、血浆凝血酶-抗凝血酶Ⅲ复合物(TAT)、血浆组织型纤溶酶原激活物(t-PA)、血浆纤溶酶原激活物抑制物(PAI-1),并在术后24h行下肢静脉超声多普勒检查。结果①非高脂血症组在气腹后TAT和t-PA水平明显增高(P<0.05),高脂血症组患者气腹后TAT和PAI-1水平有明显增高(P<0.05);②两组术后超声多普勒检查未见血栓形成。结论高脂血症患者实施腹腔镜胆囊切除术后存在高凝状态,因此重视高脂血症患者血栓前状态,采取预防措施对防治血栓并发症有重要意义。
Objective To study the effect of laparoscopic cholecystectomy on coagulation and fibrinolysis in patients with hyperlipidemia before and after operation. Methods Sixty patients undergoing laparoscopic cholecystectomy were divided into non-hyperlipidemia group and hyperlipidemia group. The dorsal venous blood was collected before pneumoperitoneum induction and at the end of surgery after induction of general anesthesia. Thrombomodulin TM), plasma thrombin-antithrombin III complex (TAT), plasma tissue plasminogen activator (t-PA) and plasma plasminogen activator inhibitor (PAI-1) 24 h after venovenous ultrasonography Doppler examination. Results ① The levels of TAT and t-PA in the non-hyperlipemia group were significantly increased after pneumoperitoneum (P <0.05), and the levels of TAT and PAI-1 in the hyperlipidemia group were significantly increased after pneumoperitoneum (P <0.05). ② Two groups of postoperative ultrasound Doppler examination no thrombosis. Conclusion Hyperlipidemia patients have hypercoagulable state after laparoscopic cholecystectomy. Therefore, it is important to consider the prethrombosis state in patients with hyperlipidemia and preventative measures to prevent and treat thromboembolic complications.