Ispitivanje funkcije trombocita i primena rotacijske tromboelastometrije u cilju racionalizacije hemoterapije tokom revaskularizacije miokarda i hirurškog tretmana srčanih zalistaka

Danijela Vuković, Tanja Živković, Milena Todorović, Branko Čalija, Petar Vuković, Bela Balint

Med Reč 2020; 1(3): 119–126

https://doi.org/10.5937/medrec2003119V

Apstrakt

Primenom intraoperativnog spasavanja krvi/eritrocita (ISK/E) u rutinskom radu, racionalizovanom upotrebom alogenih hemoprodukata i hemostatski aktivnih medikamenata – a na osnovu nalaza monitoringa „point-of-care” (POC) – moguće je doprineti boljoj dijagnostici i proceni rizika i terapiji obil­nih krvarenja, uz redukciju perioperativnog morbiditeta i mor­taliteta kod kardiohirurških bolesnika.

Ova studija je realizovana prospektivnom analizom funkcije trombocita metodom „multiple platelet function analyzer” (MEA; primena Multiplate) sistema i ispitivanjem hemostaze rotacijskom tromboelastometrijom (ROTEM) tokom i nepo­sredno posle revaskularizacije miokarda i hirurškog tretmana valvula u IKVB „Dedinje” za šestogodišnji periodu kod 1021 bolesnika, odabranih metodom slučajnog izbora.

Cilj studije je bio procena uticaja primene ISK/E i hemostatskih lekova – indikovanih na osnovu rezultata ispitivanja broja i funkcije trombocita (Multiplate) i monitoringa hemostaze (ROTEM) u odnosu na transfuziju alogenih hemoprodukata – na pojavu krvarenja, efekat tretmana i klinički ishod kod bolesnika.

U perioperativnom periodu, ukupno 617 (60,4%) bolesnika je tretirano samo reinfuzijom ISK/E. Ostali bolesnici (404; 39,6%) primali su i alogene hemoprodukte. Njih 391 (38,3%) su zbrinuti (uz ISK/E) transfuzijom jedne do tri jedinice alogenih eritrocita. Politransfundovnih (tipično 10–15 jedinica) bole­snika je bilo svega 13 (1,3%). Broj kardiohirurških reintervencija zbog krvarenja je iznosio svega 2,5%.

U zaključku, primena strategije ISK/E predstavlja efikasan i bez­bedan (redukcija imunski-posredovanih komplikacija i rizika prenosa hematogenih bolesti) terapijski pristup. Monitoringom MEA/ROTEM i implementacijom algoritma savremenog transfuzijskog tretmana, moguće je statistički značajno redukovati korišćenje alogene hemoterapije. Primena alogenih eritrocita je opravdana samo onda kada su iscrpljene sve mogućnosti autologne transfuzije i farmakološke hemostatske terapije.

Ključne reči: krvarenje, hemoprodukti, kardiohirurgija, Multiplate, ROTEM

Ceo tekst

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