徐思华

[摘要]目的 探討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 选取2015年3月～2017年3月我院收治的行腹腔镜胆囊切除术的80例胆囊炎患者作为研究对象，根据患者术后是否出现血液高凝状态分为观察组（出现血液高凝状态，n=32）和对照组（未出现血液高凝状态，n=48）。比较两组患者的一般资料、既往病史、术前收缩压、血糖、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平。采用Logistic回归法，进一步分析腹腔镜胆囊切除术后患者血液高凝状态形成的危险因素。结果 单因素分析结果显示，两组患者术前的收缩压、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、高脂血症史比较，差异有统计学意义（P<0.05）;多因素分析结果显示，高脂血症史（β=6.96，OR=1.06，95%CI=0.52～2.17）、术前收缩压水平≥128 mmHg（β=3.06，OR=1.28，95%CI=0.95～2.18）、术前低密度脂蛋白胆固醇水平≥2.82 mmol/L（β=2.78，OR=1.38，95%CI=0.63～1.79）是腹腔镜胆囊切除术后患者血液高凝状态形成的危险因素（P<0.05）。结论 腹腔镜胆囊切除术后血液高凝状态形成与术前收缩压、高脂血症史、术前低密度脂蛋白胆固醇、术前高密度脂蛋白胆固醇水平等指标密切相关，需做好相应的预防措施，减少术后血液高凝状态发生风险。

[关键词]腹腔镜胆囊切除术;血液高凝状态;高脂血症;收缩压;低密度脂蛋白胆固醇;影响因素

[中图分类号] R575.61          [文献标识码] A          [文章编号] 1674-4721（2020）7（b）-0043-04

Influencing factors of the formation of blood hypercoagulability in the patients after laparoscopic cholecystectomy

XU Si-hua

Department of General Surgery， the First People′s Hospital of Fuzhou City， Jiangxi Province， Fuzhou   344000， China

[Abstract] Objective To explore the influencing factors of the formation of blood hypercoagulability in the patients after laparoscopic cholecystectomy. Methods From March 2015 to March 2017， 80 patients with cholecystitis who underwent laparoscopic cholecystectomy in our hospital were selected as study subjects. Patients were divided into observation group （hypercoagulable state， n=32） and control group （no hypercoagulable state， n=48） according to whether patients had hypercoagulable state after surgery. General information， previous medical history， preoperative systolic blood pressure， blood glucose， high-density lipoprotein cholesterol cholesterol， and low-density lipoprotein cholesterol levels were compared between the two groups. Logistic regression was used to further analyze the risk factors of blood hypercoagulability in patients after laparoscopic cholecystectomy. Results The results of univariate analysis showed that the preoperative systolic blood pressure， high-density lipoprotein cholesterol， low-density lipoprotein cholesterol， and history of hyperlipidemia of the two groups had statistically significant differences （P<0.05）. Multivariate analysis results suggested that history of hyperlipidemia （β=6.96， OR=1.06， 95%CI=0.52-2.17）， preoperative systolic blood pressure level ≥128 mmHg （β=3.06， OR=1.28， 95%CI=0.95-2.18）， and preoperative low-density lipoprotein cholesterol level ≥2.82 mmol/L （β=2.78， OR=1.38， 95%CI=0.63-1.79） were risk factors for the formation of blood hypercoagulability in the patients after laparoscopic cholecystectomy （P<0.05）. Conclusion The formation of blood hypercoagulability after laparoscopic cholecystectomy is closely related to preoperative systolic blood pressure， history of hyperlipidemia， preoperative low-density lipoprotein cholesterol， preoperative high-density lipoprotein cholesterol level and other indicators. Corresponding precautions need to be taken to reduce the risk of postoperative blood hypercoagulability.

[Key words] Laparoscopic cholecystectomy; Blood hypercoagulability; Hyperlipemia; Systolic pressure; Low-density lipoprotein cholesterol; Influencing factors

[基金项目]江西省抚州市社会发展指导性科技计划项目（抚科计字[2017]25号34）

胆囊炎是临床比较常见的疾病类型，发病率高，手术方案是治疗胆囊炎的常用手段。传统开腹式手术的创伤明显、恢复慢、并发症多、预后质量差，腹腔镜技术的发展完善，为胆囊炎的治疗提供了新的发展方向，作为一种新兴的微创手术方式，腹腔镜技术顺应了时代发展的需要。相关器械设备的更新换代和医护人员操作水平的提升，使得腹腔镜技术在外科手术的治疗中，发挥着越来越重要的作用[1]。相比于传统开腹式手术，具有安全性高、出血量少、术后并发症发生率低等优势，因此易被广大胆囊炎患者接受。……