The Effects Of PaCO2on Coagulation And Fibrinolysis From Laparoscopic Surgery Patients

Purpose Research The influence of laparoscopic abdominal surgery patients arterial pressure of carbon dioxide to body blood coagulation and fibrinolysis system, and the main influence mechanism.Method The experiment1:33patients need laparoscopic abdominal surgery were randomly divided into three groups, hyperventilation group(PET-CO2:25-35mmHg),normal ventilation group(PET-CO2:35-45mmHg),and carbon dioxide accumulation group(PET-CO2:45-55mmHg). In preoperative clinical, respectively after1h and gasless laparoscopic end, detection prothrombin time, activate part blood coagulation live enzyme time and fibrinogen and the d-dimer content. The experiment2:The other20cases of laparoscopic abdominal surgery patients, trials are divided into the control group:hypercapnia group(PET-CO2:45-55mmHg) and the experimental group:hypercapnia NaHCO3correct group. After an hour gasless laparoscopic, the experimental group’s PH value is corrected by NaHCO3liquid to make sure its’in the normal range:7.35-7.45, at the same time, the same amount of saline was given to the control group after an hour gasless laparoscopic. The blood prothrombin time (PT), activate part blood coagulation live enzyme (APTT) and time the fibrinogen in plasma (FIB), the d-dimer (D-D) content were measured by two selecting time point:intervention30min, the end of the gasless laparoscopic. All data was statistics processed with SPASS18.0package. Measurement of the material in the group use the single factor analysis of variance, the comparison between the groups use SNK method and the test of repetitive measure anova18.0software packages. P<0.05is the key for judging the differences significant level.Results The experiment1:Three groups have no significant differences in the factors such as sex ratio, age structure, body mass and so on. PT value in the three groups all rise, the value of end comparing to preoperative value have statistical significance (P<0.05), but there were no differences between groups statistical significance (P>0.05). The d-dimer of three group patients are increased after an hour gasless laparoscopic and at end, comparing to the preoperative value, differences are significant (P<0.05). After comparison between three groups, the comparative difference of gasless laparoscopic1hour was not statistically significant (p>0.05), at the end of the gasless laparoscopic, comparing difference was statistical significance (p<0.05). FIB value each point were improved after gasless laparoscopic difference was statistically significant (P<0.05), but the difference between each group was not statistically significant (P>0.05). Three groups APTT gasless laparoscopic after the point difference was statistically significant (P>0.05), comparative differences between groups was statistically significant (P>0.05).The experiment2:Two groups have no significant differences in the factors such as sex ratio, age structure and body mass. Before and after the intervention, the PH value and PaCO2of experiment group are allowed. The comparative differences of PT and D-D value in two groups at the end were statistically significant (P<0.05), the changes have been even more pronounced in experiment group, the comparative differences of FIB and APTT value between groups were not statistically significant (P>0.05).Conclusion (1)When gasless laparoscopic is taking, arterial blood carbon dioxide pressure can affect coagulation and fibrinolysis system function.(2) The influence to coagulation and fibrinolysis system function, at least in part, is the change of plasma hydrogen ion concentration to work.