良性疾病手术后28天持续存在的高凝状态：一项前瞻性队列研究
28 day post-operative persisted hypercoagulability after surgery for benign diseases: a prospective cohort study.
作者信息
Ulrych Jan, Kvasnicka Tomas, Fryba Vladimir, Komarc Martin, Malikova Ivana, Burget Filip, Brzezkova Radka, Kvasnicka Jan, Krska Zdenek, Kvasnicka Jan
机构信息
1st Department of Surgery - Department of Abdominal, Thoracic Surgery and Traumatology; First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Thrombotic Center, Institute of Medical Biochemistry and Laboratory Diagnostics, General University Hospital, Charles University, Prague, Czech Republic.
出版信息
BMC Surg. 2016 Apr 6;16:16. doi: 10.1186/s12893-016-0128-3.
BACKGROUND
Surgery for benign disease is associated with a low-risk of developing venous thromboembolism (VTE). Despite a relatively low incidence of postoperative VTE in patients after elective cholecystectomy and abdominal hernia repair there are data proving hypercoagulability in the early postoperative period. We focused on assessment of the systemic inflammatory response and coagulation status in these surgical patients after hospital discharge.
METHODS
Prospectively, patients who underwent surgery for benign disease were included. Two hundred sixteen patients were enrolled - 90 patients in laparoscopic cholecystectomy (LC) group and 126 patients in hernia surgery (HS) group. Risk assessment of VTE according to the Caprini risk assessment model was performed in all patients. Prevalence of VTE in postoperative period was observed. Markers of systemic inflammatory response (IL-6, CRP, α-1-acid glycoprotein, transferrin) and coagulation markers (PLT, fibrinogen, prothrombin fragment F1 + 2 and D-dimer) were measured before surgery, on 7-10th postoperative day and on 28-30th postoperative day.
RESULTS
Clinically apparent deep vein thrombosis was diagnosed in only one patient - 0.46%. Statistically significant elevation of inflammatory markers IL-6, CRP and α-1-acid glycoprotein (p < 0.001; all) were proved in both groups of patients on 7-10th postoperative day. Statistically significant elevation of coagulation markers PLT, fibrinogen, prothrombin fragment F1 + 2 and D-dimer (p < 0.001; all) were proved in LC and HS groups on 7-10th postoperative day. No statistical difference was observed in IL-6, CRP and α-1-acid glycoprotein levels a month after surgery as compared with preoperative levels within each group. Statistically significant elevation of fibrinogen and prothrombin fragment F1 + 2 levels (p < 0.001; both) persisted on 28-30th postoperative day in both groups. Persisted elevation of D-dimer levels was proved only in HS group (p < 0.001), not in LC group (p = 0.138), a month after surgery.
CONCLUSIONS
Activated systemic inflammatory response and hypercoagulable condition were verified in patients after laparoscopic cholecystectomy and hernia surgery after their hospital discharge. Hypercoagulability persisted even a month after surgery. Nevertheless, we observed very low prevalence of clinically apparent VTE in patients with in-hospital postoperative VTE prophylaxis.
TRIAL REGISTRATION
Trials of the Czech Ministry of Health No. RVO-VFN64165 and NT 13251-4 .
背景
良性疾病手术与静脉血栓栓塞症（VTE）发生风险较低相关。尽管择期胆囊切除术和腹外疝修补术后患者术后VTE发病率相对较低，但有数据证明术后早期存在高凝状态。我们重点评估了这些手术患者出院后的全身炎症反应和凝血状态。
方法
前瞻性纳入接受良性疾病手术的患者。共纳入216例患者——腹腔镜胆囊切除术（LC）组90例患者和疝手术（HS）组126例患者。对所有患者根据Caprini风险评估模型进行VTE风险评估。观察术后VTE的发生率。在手术前、术后第7 - 10天和术后第28 - 30天测量全身炎症反应标志物（IL - 6、CRP、α-1-酸性糖蛋白、转铁蛋白）和凝血标志物（PLT、纤维蛋白原、凝血酶原片段F1+2和D - 二聚体）。
结果
仅1例患者被诊断为临床明显的深静脉血栓形成——发生率为0.46%。两组患者在术后第7 - 10天炎症标志物IL - 6、CRP和α-1-酸性糖蛋白均有统计学意义的升高（p < 0.001；所有指标）。LC组和HS组在术后第7 - 10天凝血标志物PLT、纤维蛋白原、凝血酶原片段F1+2和D - 二聚体均有统计学意义的升高（p < 0.001；所有指标）。与术前水平相比，每组术后1个月IL - 6、CRP和α-1-酸性糖蛋白水平无统计学差异。两组在术后第28 - 30天纤维蛋白原和凝血酶原片段F1+2水平仍有统计学意义的升高（p < 0.001；两者）。术后1个月，仅HS组D - 二聚体水平持续升高（p < 0.001），LC组无升高（p = 0.138）。
结论
腹腔镜胆囊切除术和疝手术后患者出院后证实存在激活的全身炎症反应和高凝状态。高凝状态在术后1个月仍持续存在。然而，我们观察到接受院内术后VTE预防的患者临床明显VTE的发生率非常低。
试验注册
捷克卫生部试验编号RVO - VFN64165和NT 13251 - 4 。
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