Diagnosis and Correction of Perioperative Hemostatic Disorders at Hepatic Surgery

Hepatic surgical interventions are highly traumatic and time-consuming and during these operations the hemostatic system is exposed to compound actions that lead to impaired organ and tissue microcirculation, thromboses, and coagulopathic hemorrhages.

Objective: to enhance the efficiency of instrumental diagnosis and correction of perioperative hemostatic disorders during major hepatic surgical interventions.

Subjects and methods: 80 patients divided into 3 groups were examined. A control group comprised apparently healthy individuals (donors) the values of whose hemostatic parameters were taken as normal ones. A study group consisted of patients who received conventional preoperative intensive care. Thirty patients were given complex perioperative hemostatic correction.

Results. During major hepatic surgical interventions, impairments of the basic links of the hemostatic system are characterized by the development of prethrombosis: the enhanced vascular thrombocytic and hypercoagulant state of enzymatic hemostatic links, and pronounced fibrinolytic suppression. Rapid hemoviscosimetric parameters correlate with classical biochemical parameters and have rather high sensitivity and specificity. The pathogenetically grounded use of a combination of low molecular-weight heparin and the antioxidant mexidole enhances the efficiency of correction of perioperative impairments of the basic hemostatic links during major hepatic operations.

1. Wolfe W. G. (ed.) Major problems in clinical surgery. Philadelphia: Saunders; 1990.

2. Баркаган З. С., Момот А. П. Диагностика и контролируемая терапия нарушений гемостаза. М.; 2001.

3. Авдеев С. В. Анестезиологическое обеспечение при операциях резекции печени. Автореф….дис. д-ра мед. наук. М.; 2003.

4. Каменева Е. А., Григорьев Е. В., Разумов А. С. и др. Диагностика и коррекция нарушений гемостаза при тяжелой черепно-мозговой травме. Общая реаниматология 2006; 2 (1): 12—16.

5. Тютрин И. И. Инструментальная оценка системы гемостаза. Томск; 2000.

6. Буланов А. Ю., Городецкий В. М., Шулутко Е. М. Протокол терапии острой кровопотери: основные положения. Вестн. интенс. Терапии 2004; 5: 193—195.

7. Демидова Н. Ю., Григорьев Е. В., Разумов А. С. и др. Нарушения компонентов системы гемостаза во время обширных операций на органах гепатопанкреатодуоденальной зоны. Вестн. интенс. Терапии 2004; 5: 199—200.

8. Демидова Н. Ю., Григорьев Е. В., Разумов А. С. и др. Дифференцированный выбор антикоагулянтной терапии при обширных резекциях печени. Медицина в Кузбассе 2005; 1: 133—134.