Zostautiene Indre, Zvinienė Kristina, Trepenaitis Darius, Gerbutavičius Rolandas, Mickevičius Antanas, Gerbutavičienė Rima, Kiudelis Mindaugas
Clinic of Radiology, Medicine Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Clinic of Anesthesiology, Medicine Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Wideochir Inne Tech Maloinwazyjne. 2017;12(1):19-27. doi: 10.5114/wiitm.2017.66474. Epub 2017 Mar 13.
Thromboelastography (TEG) is a technique that measures coagulation processes and surveys the properties of a viscoelastic blood clot, from its formation to lysis.
To determine the possible hypercoagulability state and the effect of antithrombotic prophylaxis on thromboelastogram results and development of venous thrombosis during laparoscopic fundoplication.
The study was performed on 106 patients who were randomized into two groups. The first group received low-molecular-weight heparin (LMWH) 12 h before the operation, and 6 and 30 h after it. The second group received LMWH only 1 h before the laparoscopic fundoplication. The TEG profile was collected before LMWH injection, 1 h after the introduction of the laparoscope and 15 min after the surgery was completed.
There was no significant difference in thromboelastography R-time between the groups before low-molecular-weight heparin injection. In group I preoperative R-values significantly decreased 1 h after the introduction of the laparoscope, after the end of surgery and on the third postoperative day. K-time values decreased significantly on the third postoperative day compared with the results before low-molecular-weight heparin injection, and after the operation. In group II, preoperative R-values significantly decreased 1 h after the introduction of the laparoscope, and after surgery. K-time values did not change significantly during or after the laparoscopic operation.
Our study results demonstrated that the hypercoagulation state (according to the TEG results) was observed during and after laparoscopic fundoplication in patients when LMWH was administered 12 h before the operation together with intraoperative intermittent pneumatic compression. The optimal anticoagulation was obtained when LMWH was administered 1 h before fundoplication.
血栓弹力图（TEG）是一种测量凝血过程并监测从形成到溶解的粘弹性血凝块特性的技术。
确定腹腔镜胃底折叠术期间可能的高凝状态以及抗血栓预防对血栓弹力图结果和静脉血栓形成发展的影响。
对106例患者进行了研究，这些患者被随机分为两组。第一组在手术前12小时、术后6小时和30小时接受低分子量肝素（LMWH）。第二组仅在腹腔镜胃底折叠术前1小时接受LMWH。在注射LMWH前、腹腔镜插入后1小时和手术完成后15分钟收集TEG图谱。
在注射低分子量肝素前，两组之间的血栓弹力图R时间没有显著差异。在第一组中，腹腔镜插入后1小时、手术结束时和术后第三天，术前R值显著降低。与注射低分子量肝素前及手术后的结果相比，术后第三天K时间值显著降低。在第二组中，腹腔镜插入后1小时和手术后，术前R值显著降低。在腹腔镜手术期间或之后，K时间值没有显著变化。
我们的研究结果表明，如果在手术前12小时给予LMWH并联合术中间歇性气动压迫，腹腔镜胃底折叠术期间及术后患者会出现高凝状态（根据TEG结果）。在胃底折叠术前1小时给予LMWH可获得最佳抗凝效果。
