rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2014-3-6-14rmt-1397Research ArticleКРИТИЧЕСКИЕ СОСТОЯНИЯ В АКУШЕРСТВЕ И НЕОНАТОЛОГИИCRITICAL CONDITIONS IN OBSTETRICS AND NEONATOLOGYОЦЕНКА ЭФФЕКТИВНОСТИ ЛЕЧЕНИЯ МАССИВНЫХ АКУШЕРСКИХ КРОВОТЕЧЕНИЙEvaluation of the Efficiency of Treatment for Massive Obstetric HemorrhageБариновС. В.BarinovS. V.МедянниковаИ. В.MedyannikovaI. V.mediren@gmail.comДолгихВ. Т.DolgikhV. T.Омская государственная медицинская академия Минздрава РФ, ОмскРоссияOmsk State Medical Academy, Ministry of Health of the Russian Federation, OmskRussian Federation201428062014103614Copyright © Баринов С., Медянникова И., Долгих В., 20142014Баринов С., Медянникова И., Долгих В.Barinov S., Medyannikova I., Dolgikh V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/1397

Цель исследования — оценить эффективность терапии массивных акушерских кровотечений на основе применения тромбоэластографии (ТЭГ).

Материал и методы

Материал и методы. Обследовано 66 пациенток с массивным акушерским кровотечением, разбитых на две группы: основную (А; n=37) и группу сравнения (В; n=29). Контрольную группу (С; n=30) составили женщины с физиологической кровопотерей в родах. Эффективность использования ТЭГ оценивали по объему кровопотери и частоте гистерэктомии.

Результаты

Результаты. Наибольшей прогностической возможностью определения риска массивного акушерского кровотечения обладает показатель плотности фибринового сгустка, MA [AUC=0,83 (95%CI 0,79—0,87), р=0,001]. Лечебно-диагностический комплекс при массивных акушерских кровотечениях c использованием ТЭГ позволяет уменьшить число гистерэктомий в 3,1 раза (р=0,02), снизить объем кровопотери в 1,3 раза (р=0,03), сократить использование свежезамороженной плазмы в 2,0 раза (р=0,01).

Заключение

Заключение. Экспресс-оценка состояния свертывающей системы крови на приборе TEG® 5000 (Haemoscope Corp., USA) позволяет проводить своевременную патогенетически обоснованную терапию, предупредить развитие критического состояния и реализовать органосохраняющую тактику. 

Objective

Objective: to evaluate the efficiency of therapy for massive obstetric hemorrhage, by applying thromboelastography (TEG).

Subjects and methods

Subjects and methods. Sixty six patients with massive obstetric hemorrhage who were divided into two groups: a study (A; n=37) and comparison (B; n=29) groups were examined. A control group (C; n=30) comprised women with physiological blood loss during labor. The efficiency of TEG was evaluated from the volume of blood loss and the frequency of hysterectomy.

Results

Results. Fibrin clot density, MA have the highest prognostic capacity to identify the risk of massive obstetric hemorrhage [AUC=0.83 (95% CI 0.79—0.87); р=0.001]. A therapeutic and diagnostic set for massive obstetric hemorrhage, by applying TEG, can reduce the number of hysterectomies by 3. 1 times (p=0.02), the volume of blood loss by 1.3 times (p=0.03), and the use of fresh frozen plasma by 2.0 times (p=0.01).

Conclusion

Conclusion. Rapid evaluation of the blood coagulation system, by using a TEG® 5000 device (Haemoscope Corp., USA) makes it possible to perform timely pathogenetic sound therapy, to prevent a critical condition, and to implement organ-sparing tactics.  

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The authors declare that there are no conflicts of interest present.