Metrika članka

  • citati u SCindeksu: 0
  • citati u CrossRef-u:0
  • citati u Google Scholaru:[=>]
  • posete u poslednjih 30 dana:6
  • preuzimanja u poslednjih 30 dana:0
članak: 9 od 616  
Back povratak na rezultate
Acta medica Medianae
2019, vol. 58, br. 1, str. 64-81
jezik rada: engleski
vrsta rada: izvorni naučni članak
doi:10.5633/amm.2019.0110

Creative Commons License 4.0
Poremećaji koagulacionog statusa i hemostaze kao prognostički parametri neposrednih i ranih rezultata nakon hirurške revaskularizacije miokarda
aKlinički centar Niš, Klinika za kardiohirurgiju, Niš + Univerzitet u Nišu, Medicinski fakultet, Niš
bKlinički centar Niš
cInstitut za javno zdravlje Niš, Niš

e-adresa: drdraganmilic@gmail.com

Sažetak

Hirurška revaskularizacija miokarda predstavlja jednu od najčešće izvođenih hirurških procedura u svetu. Vremenom, razvojem tehnologije i savremenih dijagnostičkih postupaka kao i unapređenjem hirurške tehnike, stopa smrtnosti kod elektivnih nekomplikovanih slučajeva pala je na ispod 2%. Ipak, i pored izuzetnog razvoja hirurške metode, stopa postoperativnih komplikacija koje mogu ugroziti bolesnike kreće se i preko 10%. Cilj ovog istraživanja bio je da se definiše grupa bolesnika sa povećanim rizikom od postoperativnih komplikacija u zavisnosti od poremećaja koagulacionog statusa i hemostaze. Sprovedeno je prospektivno, nerandomizovano istraživanje koje je obuhvatilo 28 bolesnika koji su podvrgnuti hirurškoj revaskularizaciji miokarda u Klinici za kardiohirurgiju KC Niš od januara do aprila meseca 2017. godine. Preoperativno, kao i tri sata, 24 sata, 48 sati, tri dana i pet dana postoperativno, određivani su sledeći parametri: krvna slika, parametri inflamacije (C reaktivni protein, presepsin); koagulacioni status (protrombinsko vreme, International Normalized Ratio, aktivisano parcijalno tromboplastinsko vreme, fibrinogen, anti-trombin III, D dimer). Jedini preoperativni nezavisni prognostički parametar povećane postoperativne drenaže bio je INR. ACT je bio nezavisni postoperativni prognostički parametar povećane postoperativne drenaže verovatno zbog odloženog ili protrahovanog dejstva heparina. Parametri inflamacije nisu pokazali povezanost sa nastankom postoperativnih komplikacija. U odnosu na bolesnike bez krvarenja, kod onih sa krvarenjem evidentirane su značajno više vrednosti uree i razlike vrednosti APTT preoperativno i na kraju perioda praćenja. Multivarijantna logistička regresiona analiza je kao jedini faktor značajno povezan sa rizikom za nastanak krvarenja potvrdila razliku vrednosti APTT preoperativno i na kraju perioda praćenja. Multi-varijantna linearna regresiona analiza je kao jedini faktor značajno povezan sa promenom vrednosti ukupno date alogene transfuzije potvrdila vrednost uree. Povećanje nivoa uree povezano je sa porastom vrednosti ukupno date alogene transfuzije. Korelaciona analiza je pokazala da je povećan broj dana boravka u intenzivnoj nezi bio značajno povezan sa ženskim polom, povećanjem broja graftova i povišenim vrednostima trajanja EKK, vremena klemovanja, vrednosti HCT, PT, INR preoperativno i na kraju perioda praćenja. Hirurška revaskularizacija miokarda je bezbedna i sigurna metoda sa minimalnom stopom morbiditeta. Primenom savremenih metoda za preoperativni monitoring hemostaze može se značajno smanjiti rizik postoperativnog krvarenja i smanjiti potreba za transfuzijom crvenih krvnih zrnaca i drugih derivata krvi.

Ključne reči

Reference

Novododat članak: provera, normiranje i linkovanje referenci u toku.
De Backer G. Epidemiology and prevention of cardiovascular disease: Quo vadis? Eur J Prev Cardiol 2017; 24(7): 768-72. [CrossRef][PubMed]
Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J 2014; 35(42): 2929. [CrossRef][PubMed]
Fuster V, Kelly BB, editors. Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. Washington (DC): National Academies Press (US); 2010
Incidencija i mortalitet od akutnog koronarnog sindroma u 2006, 2007, 2008, 2009, Srbija. Institut za javno zdravlje Republike Srbije "Dr Milan Jovanović Batut"; Available from: http://www.batut.org.rs
Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, et al. Guidelines on myocardialrevascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2010; 31(20): 2501-55. [CrossRef][PubMed]
Herzog CA, Ma JZ, Collins AJ. Comparative survival of dialysis patients in the United Statesafter coronary angioplasty, coronary artery stenting, and coronary artery bypass surgery andimpact of diabetes. Circulation 2002; 106(17): 2207-11. [CrossRef][PubMed]
Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F, et al. Guidelines on themanagement of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J 2006; 27(11): 1341-81. [CrossRef][PubMed]
Trullàs JC, González-Franco Á. Major developments in the 2016 european guidelines for heart failure. Rev Clin Esp 2017; 217(7): 405-9. [CrossRef][PubMed]
US Department of Health and Human Services: The 2011 national blood collection and utilization survey report. Washington, DC: US Department of Health and Human Services-Office of the Assistant Secretary for Health. 2011; 15 Available from: https://www.aabb.org/research/hemovigilance/bloods urvey/Documents/11-nbcus-report.pdf
Robich MP, Koch CG, Johnston DR, Schiltz N, Chandran Pillai A, Hussain ST, et al. Trends in blood utilization in United States cardiac surgical patients. Transfusion 2015; 55(4): 805-14. [CrossRef][PubMed]
Geissler RG, Rotering H, Buddendick H, Franz D, Bunzemeier H, Roeder N, et al. Utilisation of blood components in cardiac surgery: a single-centre retrospective analysis with regard to diagnosis-related procedures. Transfus Med Hemother 2015; 42(2): 75-82. [CrossRef][PubMed]
Stoicea N, Bergese SD, Ackermann W, Moran KR, Hamilton C, Joseph N, et al. Current status of blood transfusion and antifibrinolytic therapy in orthopedic surgeries. Front Surg 2015; 2:3. [CrossRef][PubMed]
Koch CG. Tolerating anemia: taking aim at the right target before pulling the transfusion trigger. Transfusion 2014;54(10 Pt 2):2595-7. [CrossRef][PubMed]
Ad N, Massimiano PS, Burton NA, Halpin L, Pritchard G, Shuman DJ, et al. Effect of patient age on blood product transfusion after cardiac surgery. J Thorac Cardiovasc Surg 2015; 150(1): 209-14. [CrossRef][PubMed]
Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, et al. Anemia and blood transfusion in critically ill patients. JAMA 2002; 288(12): 1499-507. [CrossRef][PubMed]
Anía BJ, Suman VJ, Fairbanks VF, Rademacher DM, Melton LJ 3rd.. Incidence of anemia in older people: an epidemiologic study in a well defined population. J Am Geriatr Soc 1997; 45(7): 825-31. [CrossRef][PubMed]
Dejam A, Malley BE, Feng M, Cismondi F, Park S, Samani S, et al. The effect of age and clinical circumstances on the outcome of red blood cell transfusion in critically ill patients. Crit Care 2014; 18(4): 487. [CrossRef][PubMed]
Rodriguez RM, Corwin HL, Gettinger A, Corwin MJ, Gubler D, Pearl RG. Nutritional deficiencies and blunted erythropoietin response as causes of the anemia of critical illness. J Crit Care 2001; 16(1): 36-41. [CrossRef][PubMed]
Corwin HL, Parsonnet KC, Gettinger A. RBC transfusion in the ICU. Is there a reason? Chest 1995; 108(3): 767-71. [CrossRef][PubMed]
Littenberg B, Corwin H, Gettinger A, Leichter J, Aubuchon J. A practice guideline and decision aid for blood transfusion.Immunohematology 1995; 11(3): 88-94. [PubMed]
Lako A, Bilali S, Memishaj S, Daka A, Dedej T, Nurka T, et al. The impact of blood use on patients undergoing coronary artery bypass surgery: a prospective study. G Chir 2014; 35(1-2): 20-6. [CrossRef][PubMed]
Westenbrink BD, Kleijn L, de Boer RA, Tijssen JG, Warnica WJ, Baillot R, et al. Sustained postoperative anaemia is associated with an impaired outcome after coronary artery bypass graft surgery: insights from the IMAGINE trial. Heart 2011; 97(19): 1590-6. [CrossRef][PubMed]
Patel NN, Avlonitis VS, Jones HE, Reeves BC, Sterne JA, Murphy GJ. Indications for red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis. Lancet Haematol 2015; 2(12): e543-53. [CrossRef][PubMed]
Murphy GJ, Reeves BC, Rogers CA, Rizvi SI, Culliford L, Angelini GD. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 2007; 116 (22): 2544-52. [CrossRef][PubMed]
Litmathe J, Boeken U, Feindt P, Gams E. Predictors of homologous blood transfusion for patients undergoing open heart surgery. Thorac Cardiovasc Surg 2003; 51(1):17-21. [CrossRef][PubMed]
Pattakos G, Koch CG, Brizzio ME, Batizy LH, Sabik JF 3rd, Blackstone EH, et al. Outcome of patients who refuse transfusion after cardiac surgery: a natural experiment with severe blood conservation. Arch Intern Med 2012; 172(15): 1154-60. [CrossRef][PubMed]
Loor G, Li L, Sabik JF, 3rd, Rajeswaran J, Blackstone EH, Koch CG. Nadir hematocrit during cardiopulmonary bypass: end-organ dysfunction and mortality. J Thorac Cardiovasc Surg 2012; 144(3): 654-662. [CrossRef]
Paone G, Herbert MA, Theurer PF, Bell GF, Williams JK, Shannon FL, et al. Red blood cells and mortality after coronary artery bypass graft surgery: an analysis of 672 operative deaths. Ann Thorac Surg 2015; 99(5): 1583-9. [CrossRef][PubMed]
Shaw RE, Johnson CK, Ferrari G, Zapolanski A, Brizzio M, Rioux N, et al. Balancing the benefits and risks of blood transfusions in patients undergoing cardiac surgery: a propensity-matched analysis. Interact Cardiovasc Thorac Surg 2013; 17(1):96-102. [CrossRef][PubMed]
Kuduvalli M, Oo AY, Newall N, Grayson AD, Jackson M, Desmond MJ, et al. Effect of peri-operative red blood cell transfusion on 30-day and 1-year mortality following coronary artery bypass surgery. Eur J Cardiothorac Surg 2005; 27(4): 592-8. [CrossRef][PubMed]
Engoren MC, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ. Effect of blood transfusion on long-term survival after cardiac operation. Ann Thorac Surg 2002; 74(4): 1180-6. [CrossRef][PubMed]
Möhnle P, Snyder-Ramos SA, Miao Y, Kulier A, Böttiger BW, Levin J, et al. Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients. Intensive Care Med 2011; 37 (1): 97-109. [CrossRef][PubMed]
Loor G, Rajeswaran J, Li L, Sabik JF 3rd, Blackstone EH, McCrae KR, et al. The least of 3 evils: exposure to red blood cell transfusion, anemia, or both? J Thorac Cardiovasc Surg 2013; 146(6): 1480-1487. [CrossRef][PubMed]
Schwann TA, Habib JR, Khalifeh JM, Nauffal V, Bonnell M, Clancy C, et al. Effects of Blood Transfusion on Cause-Specific Late Mortality After Coronary Artery Bypass Grafting-Less Is More. Ann Thorac Surg 2016; 102(2): 465-73. [CrossRef][PubMed]
Du Pont-Thibodeau G, Harrington K, Lacroix J. Anemia and red blood cell transfusion in critically ill cardiac patients. Ann Intensive Care 2014; 4: 16. [CrossRef][PubMed]
Azarfarin R, Ashouri N, Totonchi Z, Bakhshandeh H, Yaghoubi A. Factors influencing prolonged ICU stay after open heart surgery. Res Cardiovasc Med 2014; 3(4): e20159. [PubMed]
Mehta RH, Grab JD, O'Brien SM, Glower DD, Haan CK, Gammie JS, et al. Clinical characteristics and inhospital outcomes of patients with cardiogenic shock undergoing coronary artery bypass surgery: insights from the Society of Thoracic Surgeons National CardiacDatabase. Circulation 2008; 117(7): 876-85. [CrossRef][PubMed]
Jubelirer SJ, Mousa L, Reddy U, Welch CA. Coronary artery bypass grafting (CABG) in patients with immune thrombocytopenia (ITP): a community hospital experience and review of the literature. W V Med J 2011; 107(6): 10-4. [PubMed]
Engoren M, Arslanian-Engoren C. Long-term survival in the intensive care unit after erythrocyte blood transfusion. Am J Crit Care 2009; 18(2): 124-31. [CrossRef][PubMed]
Vamvakas EC, Carven JH. RBC transfusion and postoperative length of stay in the hospital or the intensive care unit among patients undergoing coronary artery bypass graft surgery: the effects of confounding factors. Transfusion 2000; 40(38): 832-9. [CrossRef][PubMed]
Koster A, Zittermann A, Borgermann J, Knabbe C, Diekmann J, Schirmer U, et al. Transfusion of 1 and 2 units of red blood cells does not increase mortality and organ failure in patients undergoing isolated coronary artery bypass grafting. Eur J Cardiothorac Surg 2016; 49(3): 931-6. [CrossRef][PubMed]
Haanschoten MC, van Straten AH, Verstappen F, van de Kerkhof D, van Zundert AA, Soliman Hamad MA. Reducing the immediate availability of red blood cells in cardiac surgery, a single-centre experience. Neth Heart J 2015; 23(1): 28-32. [CrossRef][PubMed]
Ferraris VA. Blood transfusion in cardiac surgery: who should get transfused? Lancet Haematol 2015; 2(12). [CrossRef][PubMed]