DIAGNOSIS AND MANAGEMENT OF HEMORRHAGIC DISORDERS IN CHILDREN WITH CYANOTIC CONGENITAL HEART DISEASE UNDEGOING CARDIAC SURGERY
https://doi.org/10.17802/2306-1278-2016-1-60-70
Abstract
Purpose. To assess the functional state of hemostasis and fibrinolysis in children with cyanotic CHD before and after cardiac surgery, as well as to identify possible causes of hemorrhagic disorders to ensure adequate therapy.
Materials and Methods. Children with cyanotic CHD were enrolled into to groups: Group 1 (n=30) patients received the LPTEGguided therapy and Group 2 (n=30) patients received standard hemostatic therapy.
Results. Hypocoagulation caused by the abnormalities in the clooting phase of hemostasis was found in the study groups in the end of the main stage of cardiac surgery. CTA, TBC, ICD, ICP, MA and CPH significantly decreased compared to the control group. Therefore, haemostatic therapy in Group 1 patients included the transfusion of FF P, whereas in Group 2, in addition to the FF P transfusion, tranexamic acid and etamzilat were used. The amount and rate of blood loss did not differ significantly between the study groups. The rate of bleeding >3 ml/kg/hr during 24 hours in the postoperative day was 6.6 % in Group 1 and 10 % in Group 2.
Conclusion. The approach of differentiated LPTEG-guided therapy allows to reduce the medication load, decrease the bleeding rate by 3.3 %, decrease the ventilation time on 9.4 hours. Moreover, this approach allowed to reduce the duration of inotropic support on 24 hours as well as the ICU stay on 33.6 hours.
About the Authors
V. N. Lazaniuk
Odessa National Medical University, Odessa Regional Children’s Hospital. Odessa. Ukraine
Russian Federation
Russian Federation
15, Torgovaya st., Odessa, 65000, Ukraine Tel. +380-97-659-73-99
O. A. Tarabrin
Odessa National Medical University, Odessa Regional Children’s Hospital. Odessa. Ukraine
Russian Federation
Russian Federation
V. I. Bosenko
Odessa National Medical University, Odessa Regional Children’s Hospital. Odessa. Ukraine
Russian Federation
Russian Federation
References
1. Самсонова Н. Н., Козар Е . Ф., Климович Л . Г . Диагностика гемостазиологических нарушений в раннем послеоперационном периоде у детей первого года жизни с врожденными пороками сердца. Бюлетень НЦССХ им. А. Н. Бакулева РАМН. 2008; 6: 247–254. Samsonova N. N., Kozar E. F., Klimovich L. G. Diagnostika gemostaziologicheskih narusheniy v rannem posleoperacionnom periode u detej pervogo goda zhizni s vrozhdennymiporokami serdca. Byuleten’ NCSSH im. A. N. Bakuleva RAMN. 2008; 6: 247–254. [In Russ].
2. Харькин А. В. Комплексная интенсивная терапия у новорожденных после кардиохирургических вмешательств. Автореф. дис. … д-ра мед. наук. М.; 2008. Kharkin A. V. Kompleksnaja intensivnaja terapija u novorozhdennyh posle kardiohirurgicheskih vmeshatel’stv. [dissertation]. Мoscow; 2008. [In Russ].
3. Moganasundram S., Hunt B. J., Sykes K., Holton F., Parmar K., Durward A. et al. The relationship among thromboelastography, hemostatic variables, and bleeding after cardiopulmonary bypass surgery in children. Anesth. Analg. 2010; 110 (4): 995–1002. DOI: 10.1213/ANE.0b013e3181cd6d20.
4. Faraoni D., Van der Linden P. Factors affecting postoperative blood loss in children undergoing cardiac surgery. J. of Cardiothor. Surg. 2014; 9: 32. DOI:10.1186/1749-8090-9-32.
5. Williams G. D., Bratton S. L., Riley E. C., Ramamoorthy C. Association between age and blood loss in children undergoing open heart operations. The Annals of thoracic surgery. 1998. 66 (3): 870–875.
6. Самсонова Н. Н., Климович Л . Г ., Диасамидзе К . Э., Купряшов А. А. Использование рекомбинантного активированого фактора VII в кардиохирургии. Тромбоз, гемостаз и реология. 2011; 4: 41–46. Samsonova N. N., Klimovich L. G., Diasamidze K. E., Kupryashov A. A. Usage of recombinant activated factor vii in cardio surgery. Tromboz, gemostaz i reologija. 2011; 4: 41–46. [In Russ].
7. Бокерия Л . А., Купряшов А. А., Козар Е . Ф. и др. Роль искусственного кровообращения в развитии геморрагических осложнений у детей после коррекции врожденных пороков сердца. Детские болезни сердца и сосудов. 2011; 3: 4–14. Bokerija L. A., Kuprjashov A. A., Kozar E. F. et al. Rol’ iskusstvennogo krovoobrashhenija v razvitii gemorragicheskih oslozhnenij u detej posle korrekcii vrozhdennyh porokov serdca. Detskie bolezni serdca i sosudov. 2011; 3: 4–14. [In Russ].
8. Murugesan C., Banakal S. K., Garg R., Keshavamurthy S., Muralidhar K. The efficacy of aprotinin in arterial switch operations in infants. Anesthesia and analgesia. 2008; 107: 783–787. DOI: 10.1213/ane.0b013e31817f8b2c.
9. Тарабрин О . А., Щербаков С. С., Гавриченко Д. Г . Использование пробы с двукратной локальной гипоксией верхней конечности для определения риска тромбоопасности. Біль, знеболювання та інтенсивна терапія. 2010; 3: 6–9. Tarabrin O. A., Shсherbakov S. S., Gavrichenko D. G. Ispol’zovanie proby s dvukratnoj lokal’noj gipoksiej verhnej konechnosti dlja opredelenija riska tromboopasnosti. Bіl’, zneboljuvannja ta іntensivna terapіja. 2010; 3: 6–9. [In Russ].
10. Тютрин И . И ., Удут В. В., Шписман М. Н. Низкочастотная пьезотромбоэластография в диагностике гемостазиологических расстройств. Томск; 2013: 67. Tyutrin I. I., Udut V. V., Shpisman M. N. Nizkochastotnaja p’ezotrombojelastografija v diagnostike gemostaziologicheskih rasstrojstv. Tomsk. 2013: 67. [In Russ].
Review
For citations:
Lazaniuk V.N., Tarabrin O.A., Bosenko V.I. DIAGNOSIS AND MANAGEMENT OF HEMORRHAGIC DISORDERS IN CHILDREN WITH CYANOTIC CONGENITAL HEART DISEASE UNDEGOING CARDIAC SURGERY. Complex Issues of Cardiovascular Diseases. 2016;(1):60-70. (In Russ.) https://doi.org/10.17802/2306-1278-2016-1-60-70
Views:
877
