329 research outputs found
Πcute renal failure in patients with implanted LVAD in the early postoperative period
AKI is one of the major complications in the cardiac surgery group of patients in the world. In patients with LVAD in the short postoperative period, the situation with such a complication as AKI is associated with the state of hemodynamics and fluctuations in the parameters of the hemostasis system.
The purpose of this scientific work is to analyze the state of the blood coagulation system and its response to therapy and complications in the early postoperative period in fifty patients with implanted devices for mechanical support of the left ventricle, left ventricle assist device, LVAD, in the Silesian Heart Disease, Poland. Patients were divided into two groups, a control group receiving classical anticoagulation targeted therapy (ATT), which included the most controlled monotherapy with heparin, after reaching the target values of APTT, the addition and transition to monotherapy with warfarin until reaching the target INR and ASA, and the main, research group, who received an alternative ATT consisting of the previous one with the addition of P2Y12-receptor blockers and Xa-factors.
The results showed that the control group of patients with classical anticoagulant targeted therapy had greater mortality associated with AKI than the patients of the study group, and it was also demonstrated that the initially longer duration of surgery and intraoperative polyuria gave a greater percentage of AKI in the postoperative period.
The work was carried out within the framework of a bilateral agreement on scientific cooperation between the Department of Anesthesiology & Intensive Care at the National Medical Academy of Post-Graduate Education Named After P.L. Shupyk and the Silesian Center for Heart Diseases (Poland). This article is part of the analysis of the work on the analysis of the blood coagulation system in patients after implantation of the left ventricular mechanical circulatory support system with the analysis of such postoperative complication as acute kidney failure
Comparison of the methods of the correction of the venous thromboembolism in bariatric surgery using the low-frequency thromboelastography: our experience
Introduction. In the world of obesity and its complications annually dies about 2.8 million people. Obesity is an independent factor of the risk of venous thromboembolism (VTE), as it interferes with the internal and external pathways of coagulation, as well as in anticoagulant mechanisms, which leads to a hypercoagulation state. Reducing excess body weight in patients with morbid obesity by bariatric surgery is becoming increasingly popular, as barium therapy is an effective means of treating obesity and related concomitant diseases. Advantages of bariatric surgery are undeniable, as well as risks. Despite many blood coagulation studies, cases of thromboembolism in such patients are becoming more frequent, especially during surgical interventions and in the postoperative period, given that the operation is a trigger factor in the development of thromboembolism.
Materials and methods. A hemostasis system was studied in 63 patients with BMI> 35 kg / m2. All patients were divided into 3 groups. 1 group (n=20) - patients who received combined therapy: Enoxaparin sodium 0.1% 0.2 ml / kg 2 times a day every 12 hours and Pentoxifylline 100 mg 2 times a day every 12 hours; The 2nd group (n= 17) - patients treated with: Enoxaparin sodium 0.1% 0.2 ml / kg 2 times daily for every 12 hours; Group 3 (control): 26 people with obesity, BMI> 35, not subject to bariatric surgery. The study of the hemostasis system was carried out using low-frequency piezoelectric thromboelastography (LPTEG) immediately after hospitalization and on 1,3,5 days after bariatry. The following blood coagulation constants were checked: Contact Coagulation Intensity; intensity of coagulation drive; maximum bunch density; Fibrinolytic activity is the index of retraction and lysis of the clot.
Results. In patients of group 1 (anticoagulants + antiplatelet agents) the risk of thrombotic complications is lower, since this therapy has reduced the value at all stages of hemocoagulation to the reference values; Patients in group 2 (anticoagulants), despite the normalization of the coagulation unit, had an increase in the values of aggregation and fibrinolysis, relative to the norm, which means the risk of thrombotic complications remains high.
Conclusions. The instrumental method of NPTEG allowed to adequately estimate the system of hemocoagulation in dynamics in patients with morbid obesity, with BMI β₯ 35 kg / m2; This category of patients has shown a high risk of VTE; It has been proved that for an adequate prevention of VTE in obese patients undergoing bariatric surgery, the combination of anticoagulants and antiplatelet agents is more effective than monotherapy with anticoagulants
Low-frequency hemoviscoelastography in monitoring coagulation disorders after abdominal surgery for cancer
The state of hemostasis in pregnant women with hydramnion
Purpose. To determine the state of various stages of hemostasis in pregnant women with
hydramnion as a risk factor for premature detachment of the placenta.
Results. There was investigated the state of hemostasis in pregnant women with hydramnion
by low piezoelectric thromboelastography (LPTEG) and standard coagulogram. According to
the LPTEG results this group of women was found to have increased plasma coagulation
potential manifested in elevated constant thrombin activity (TAC) by 76.8%, the intensity of
coagulation drive (ICD) by 74.9%, maximum clot density (MA) by 16.8%, shortening of
coagulation time (T3) by 7.8% and inhibition of fibrinolysis manifested by decrease in
retraction intensity and clot lysis (RICL) by 67.7% (p<0.05).
Conclusions. The state of hemostasis in pregnant women with hydramnion is characterized
by increased plasma coagulation and inhibition of fibrinolysis potential that are factors of
preparing the womanβs body for the upcoming birth to control and minimize blood loss
Features of the hemostasis system state in patients with pulmonary tuberculosis detected by the method of low-frequency vibration piezoelectric hemocoagulography
Objective: to estimate the state of the hemostasis system in patients with tuberculosis by the method of LPHC.
Methods: the state of the hemostasis system in patients with tuberculosis was evaluated with the aid of the analyzer of the blood rheological properties ARP - 01 βMednordβ as well as by the use of a standard complex of laboratory coagulation tests. The indices characterizing the initial stages of the blood coagulation, the intensity of thrombin formation and fibrin polymerization was evaluated by the LPHC method as well as the indices, which characterize the intensity of the clot retraction and fibrinolytic activity.
Results: the comparative analysis of the state of the hemostasis system with the use of a standard coagulogram and LPHC express method in patients with tuberculosis revealed the presence of the processes of the moderate hyper-coagulation shift and suppression of fibrinolysis in them.
Conclusion: the comparative estimation of the state of the hemostasis system in patients with tubercular infection with the aid of the method of low-frequency vibration piezoelectric hemocoagulography and standard coagulation tests revealed unidirectionality of the processes. The determination of changes in the components of the regulation of aggregation of the blood condition (RABC) system by the LPHC method allows to diagnose the development of complications in the blood coagulation system in patients with tuberculosis without manifestations of the corresponding clinical symptoms
Clinical signs and risk factors of acute deep vein thrombosis of lower extremities in patients after abdominal surgery for cancer: efficiency and safety of different types of anticoagulant therapy
Complications of peripheral nerve blocks
ΠΡΠΎΠ²Π΅Π΄Π΅Π½ ΠΎΠ±Π·ΠΎΡ Π²ΡΠ΅Ρ
Π²Π΅ΡΠΎΡΡΠ½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΠΏΡΠΎΠ²ΠΎΠ΄Π½ΠΈΠΊΠΎΠ²ΠΎΠΉ Π°Π½Π΅ΡΡΠ΅Π·ΠΈΠΈ, ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ Π³Π»ΡΠ±ΠΎΠΊΠΈΠΉ ΠΈ Π²ΡΠ΅ΡΡΠΎΡΠΎΠ½Π½ΠΈΠΉ Π°Π½Π°Π»ΠΈΠ· ΠΈΡ
ΠΏΡΠΈΡΠΈΠ½, ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°ΡΡΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈ ΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΡ, Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ°, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΌΠ΅ΡΠΎΠ΄Ρ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ
ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ. Π ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΏΡΠΈΠΌΠ΅ΡΠΎΠ² ΠΏΡΠΈΠ²ΠΎΠ΄ΡΡΡΡ ΠΊΠΎΠ½ΠΊΡΠ΅ΡΠ½ΡΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ»ΡΡΠ°ΠΈThe work includes the overview of potential nerve block complications, represents comprehensive and deep analysis of possible
reasons. Clinical and physiological manifestations of each complication are considered as well as its diagnostics and methods of
prophylaxis and treatment. The work includes clinical case descriptions to show practical application of theoretical statements.
Keywords: neural block, complication of neural block, local anesthetics
ΠΠ΅ΡΠΈΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΠΉ ΠΌΠ΅Π½Π΅Π΄ΠΆΠΌΠ΅Π½Ρ Π°Π±Π΄ΠΎΠΌΠΈΠ½Π°Π»ΡΠ½ΠΎΠΉ Π³ΠΈΡΡΠ΅ΡΡΠΊΡΠΎΠΌΠΈΠΈ: Π½ΠΎΠ²ΡΠ΅ ΠΏΠΎΠ΄Ρ ΠΎΠ΄Ρ ΠΈ ΠΎΠ±Π·ΠΎΡ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΡ
ΠΠ±Π΄ΠΎΠΌΠΈΠ½Π°Π»ΡΠ½Π°Ρ Π³ΠΈΡΡΠ΅ΡΡΠΊΡΠΎΠΌΠΈΡ (ΠΠ) ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΎΠ΄Π½ΠΉ ΠΈΠ· Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΡΡ
ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ, Π²ΡΠΏΠΎΠ»Π½ΡΠ΅ΠΌΡΡ
ΠΏΡΠΈ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΡ
, Π° ΡΠ°ΠΊΠΆΠ΅ Π΄ΠΎΠ±ΡΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΡ
ΠΎΠΏΡΡ
ΠΎΠ»ΡΡ
ΠΎΡΠ³Π°Π½ΠΎΠ² ΠΆΠ΅Π½ΡΠΊΠΎΠΉ ΡΠ΅ΠΏΡΠΎΠ΄ΡΠΊΡΠΈΠ²Π½ΠΎΠΉ ΡΠΈΡΡΠ΅ΠΌΡ.
ΠΡΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠΉ ΠΏΠ΅ΡΠΈΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΠΉ ΠΌΠ΅Π½Π΅Π΄ΠΆΠΌΠ΅Π½Ρ Π·Π°Π²ΠΈΡΠΈΡ ΠΎΡ ΡΠΎΡΡΡΠ΄Π½ΠΈΡΠ΅ΡΡΠ²Π° ΠΌΠ΅ΠΆΠ΄Ρ Ρ
ΠΈΡΡΡΠ³Π°ΠΌΠΈ, Π°Π½Π΅ΡΡΠ΅Π·ΠΈΠΎΠ»ΠΎΠ³Π°ΠΌΠΈ, Π³Π΅ΠΌΠΎΡΡΠ°Π·ΠΈΠΎΠ»ΠΎΠ³Π°ΠΌΠΈ ΠΈ ΡΠ»ΡΠΆΠ±Π°ΠΌΠΈ ΡΠΏΡΠ°Π²Π»Π΅Π½ΠΈΡ
Π±ΠΎΠ»ΡΡ Π»Π΅ΡΠ΅Π±Π½ΠΎΠ³ΠΎ ΡΡΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΈ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅Ρ ΡΠΎΠ±ΠΎΠΉ ΡΠΎΡΠ΅ΡΠ°Π½ΠΈΠ΅ ΡΠΏΡΠ΅ΠΆΠ΄Π°ΡΡΠ΅ΠΉ
Π°Π½Π°Π»Π³Π΅Π·ΠΈΠΈ, ΠΎΠ±ΡΠ΅ΠΉ ΠΈ ΡΠ΅Π³ΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ Π°Π½Π΅ΡΡΠ΅Π·ΠΈΠΈ, ΠΈΠ·ΡΡΠ΅Π½ΠΈΡ ΠΈ ΡΠ΅Π³ΡΠ»ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ ΡΠΈΡΡΠ΅ΠΌΡ Π³Π΅ΠΌΠΎΡΡΠ°Π·Π°.Abdominal hysterectomy (AH) is one of the most common surgeries performed
for malignant as well as benign indications. Effective perioperative managementdepends on the cooperation between the surgeons, anesthetists, hemostasiologists
and the hospitalβs pain management service, and is a combination of preemptive
analgesia, general and regional anesthesia, studying and regulation of the functional state of the hemostasis system. The objective of this work is to present the currently available therapeutic strategies for the treatment of posthysterectomy pain
and trombotic complications in the light of our experience and the literature review
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