The effects of surgical trauma on aggregation and adhesion of platelets / 中华麻醉学杂志

ABSTRACT

Objective To investigate the effects of magnitude of surgical trauma and duration of operation on aggregation and adhesion of platelets during laparoscopy and conventional laparotomy cholecystectomy. Methods Thirty ASA Ⅰ-Ⅱpatients(male 11, female 19) undergoing elective cholecystectomy were studied . The mean age was(45 .2 ? 8.3) years and mean body weight(63.3 ?12. 6)kg. The patients were divided into two groups laparoscopy group(group LC) and laparotomy group(group OC). Patients who took any drugs which may affect blood coagulation were excluded. Blood routine examination, coagulation and bleeding time were normal in all patients. In both groups anesthesia was induced with fentanyl 0. 1-0.2mg, propofol 2mg/kg and vecuronium 0.1mg/kg and maintained with isoflurane inhalation. Venous blood samples were taken after induction of anesthesia and 1h and 2h after operation was started. 10ml of blood was withdrawn from median cubital vein for the measurement of platelet adhesion(PAdT) and plasma level of platelet membrane glycoprotein(GPⅠ b/Ⅰ x) and von Willebrand factor(vWF) . Venepuncture was made at first attempt without using tourniquet. Plastic syringes were used and first 2ml of blood withdrawn was discarded . Glass ball method was used for measurement of PAdT which was calculated according to the following equation Rate of platelet adhesion(% ) = /(No. of platelet before adhesion-No. of platelet after adhesion) No. of platelet before adhesionGP Ⅰ b/Ⅰ x and vWF levels were measured using ELISA method. Results There was no significant difference in PAdT and GP Ⅰ b/Ⅰ x and vWF levels after induction of anesthesia between two group. PadT level was significantly lower at 1 and 2h during surgery in group LC than that in group OC. GPⅠh/Ⅰx level was higher at 1h during operation in group OC than that in group LC and was much higher at 2h during surgery. vWF level decreased significantly at 2h during operation in both groups. Conclusions Platelet adhesion rate increases during operation and the severer the trauma the higher the platelet adhesion rate. GPⅠ b/Ⅰ x level is higher in group OC during operation than that in group LC probably due to severity of trauma. vWF is consumed during operation.