ZNAČAJ IMPEDANTNE AGREGOMETRIJE U KARDIOHIRURGIJI
Sažetak
Hemostaza je složen biološki proces kojim se sprečava gubitak krvi iz neoštećenog krvnog suda, kao i prekomerni gubitak cirkulišuće krvi kod povređenog krvnog suda. Za normalno funkcionisanje hemostaze neophodno je da krvni sud ima histološki normalnu građu zida, kao da je i funkcija trombocita očuvana. Von Willebrandov faktor predstavlja ključni činilac agregacije trombocita. Ovaj glikoprotein plazme vezuje se za receptore trombocita i kolagen. Trombin olakšava primarnu agregaciju prisutnih trombocita, koji nakon toga oslobađaju adenozin-difosfat (ADP), tromboksan A2 i serotonin; svi oni zajedno izazivaju posledičnu vazokonstrikciju, koja dovodi do sekundarne agregacije trombocita. Krvarenje nakon aortokoronarnog bajpasa posledica je delovanja brojnih faktora. Test agregacije trombocita u celoj krvi (impedantna agregometrija) omogućava analizu funkcije trombocita u prisustvu leukocita i eritrocita. Ova metoda se koristi za dijagnostikovanje oštećene funkcije trombocita, koja je uglavnom stečenog, a izuzetno retko urođenog karaktera.
Naše istraživanje pokazalo је da je 31% bolesnika imao postoperativno poremećenu funkciju trombocita, s tim što je postoperativno krvarenje posle 24 sata bilo statistički značajno veće kod bolesnika sa vrednostima ADP < 300 AU/min 24 sata nakon operacije, kao i TRAP < 500 AU/min 24 sata posle operacije (p = 0,002). Tri sata nakon operacije, transfuziju trombocita primila su 22 bolesnika (22,0%): ADP test ≤ 300 AU/min, ASPI ≤ 400 AU/min, TRAP ≤ 500 AU/min. Prosečno je davano 11,14 ± 4,45 doza. Dvadeset četiri časa nakon intervencije nije bilo bolesnika kojima je bila potrebna transfuzija koncentrata trombocita.
Upotreba savremenih metoda, u kombinaciji sa dokazanim kliničkim protokolima i velikim kliničkim iskustvom osoblja i uz poštovanje principa „vreme je život”, omogućava najbolje moguće zbrinjavanje bolesnika sa detektovanim poremećajem hemostaze u kardiohirurgiji.
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