Uticaj otvorene i endovaskularne rekonstrukcije aneurizme abdominalne aorte na kvalitet koaguluma meren ROTEM® testom
Sažetak
Uvod/Cilj. Poremećaji hemostaze su česti u otvorenoj (OR) i endovaskularnoj rekonstrukciji (EVAR) aneurizme abdominalne aorte (AAA). Ove promene mogu uticati na perioperativni i rani postoperativni period uzrokujući ozbiljne komplikacije. Cilj studije bio je da se uporedi uticaj OR i EVAR AAA na kvalitet koaguluma procenjen testovima rotacione tromboelastometrije (ROTEM®). Metode. Studija je obuhvatila 40 bolesnika kod kojih je izvedena elektivna operacija AAA, i koji su bili podeljeni u dve grupe (OR i EVAR grupa – po 20 bolesnika u svakoj grupi). ROTEM® test urađen je u 4 tačke: tačka 1 – 10 min pre uvođenja u anesteziju u obe grupe; tačka 2 – 10 min nakon klemovanja aorte u OR grupi i 10 min nakon otpuštanja trunkusa stent grafta u EVAR grupi; tačka 3 – 10 min nakon otpuštanja kleme sa aorte u OR grupi i 10 min nakon plasiranja stent grafta i otpuštanja klema sa femoralnih arterija u EVAR grupi; tačka 4 – jedan sat nakon operacije u obe grupe. Izvedena su tri ROTEM® testa: spoljašnji aktivacioni esej sa tkivnim faktorom (EXTEM), unutrašnji aktivacioni test sa kaolinom (INTEM) i spoljašnji aktivacioni test sa tkivnim faktorom i trombocitnim inhibitorom citohalazinom D (FIBTEM). Svi testovi uključili su procenu maksimalne čvrstine koaguluma (MČK) i trombocitna komponenta jačine koaguluma predstavljena je maksimalnom elastičnošću koaguluma (MEK). Rezultati. Nije bilo značajne razlike između grupa u godinama starosti i polu bolesnika i dijametru AAA. Trajanje operacije bilo je značajno duže kao i količina izgubljene krvi u OR nego u EVAR grupi, (p < 0,001). Nađene su značajne promene u MČF vrednostima u EXTEM-u, naročito u tački 3 (p ≤ 0,004), sa značajnom razlikom između grupa (p < 0.001). Nađena je značajna razlika između grupa u vrednostima MČK u INTEM-u u tačkama 3 i 4, što je bilo dozno zavisno od heparina. Vrednosti MČK u FIBTEM-u bile su izraženije u OR grupi nego u EVAR grupi, ali bez značajne razlike između grupa. Značajne promene u MČK vrednostima u FIBTEM-u tokom vremena nađene su u obe grupe (p < 0,001). Vrednosti MČK bile su niže u obe grupe, ali bez značajnih promena i bez značajne razlike između grupa (p = 0,105). Zaključak. Poremećaji parametara hemostaze procenjenih ROTEM® testovi bili su prisutni u OR i EVAR proceduri, ali su bili izraženiji u OR AAA. Vigilno praćenje parametara hemostaze uz pomoć ROTEM® testova može pomoći u primeni adekvatne i ciljne terapije kod bolesnika podvrgnutih EVAR i OR AAA.
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