Система гемостазу під час проведення операцій металоостеосинтезу при переломах довгих трубчастих кісток нижніх кінцівок

Abstract

Мета дослiдження — визначення вiдмiнностей впливу реґiонарної та загальної анестезiї на характер змiн функцiонального стану компонентiв системи гемостазу i фiбринолiзу пiд час операцiй металоостеосинтезу при переломах довгих трубчастих кiсток нижнiх кiнцiвок, а також ступеня тромбонебезпеки пiд час оперативного втручання на основi вивчення функцiонального стану судинно-тромбоцитарного, коагуляцiйного компонентiв системи гемостазу i фiбринолiзу та їх порушення.

Massive tissue trauma, prolonged surgical interventions, rheological disorders, significant blood loss, old age and other risk factors (including their combination) put trauma patients at high perioperative risk. Effect of surgery and anesthesia on the hemostatic system is very significant and requires careful anesthesiologist’s attention. Aim. To determinate possibilities of the functional status the system of hemostasis during operations of metallo-osteosynthesis in patients with fractures of long tubular bones of lower extremities. Materials and methods. We studied the system of hemostasis and fibrinolisys in 66 patients with fractures of long tubular bones of lower extremities before operations and after starting operation through 1–2 hours. Patients were divided into 2 groups depending on anaesthesia type: 1 group – 35 patients were performed spinal anaesyhesia, 2 group – 31 patients were performed general anaesthesia. Results. It was studied the effect of anaesthesiological providing on functional status of hemostasis during operations of metallo-osteosynthesis in patients with fractures of long tubular bones of lower extremities. The instrumental express-method of low-frequency piezoelectric hemoviscoelastography helps to screen system of hemostasis in different stages of operation, test prophylaxis of thromboembolical complications and hemorrhage, and, if necessary, treat patients in time. Conclusions. The usage of spinal anaesthesia prevents intraoperative thrombotic complications and the usage of general anaesthesia require additional measures for prevention of thrombotic complications.