METHOD FOR PREVENTION OF COAGULOPATHIC BLEEDING DURING SURGERY FOR MECHANICAL JAUNDICE.

Abstract

Background: Violation of hemostasis directly depends on the severity of hepatocyte dysfunction. Such patients may develop disseminated intravascular coagulation (DIC syndrome) and bleeding during and after surgery.

Objectives: to improve the results of treatment of coagulopathic bleeding during surgery for mechanical jaundice, through proactive therapy.

Methods: A prospective randomized clinical-controlled research was conducted according to the study protocol, which was based on the purpose of the study and objectives. The state of hemostasis was studied depending on the duration of jaundice in 79 patients with mechanical jaundice treated at the Semey Medical University Hospital, Non-Commercial Joint-Stock Company (NCJSC) at the age of 18 to 85 years, the average age was 62 years. (95% confidence interval (CI) 59.2/64.6 for average 61.9). The patients were distributed by gender in the following order: males - 30 patients (38%), females - 49 patients (62%).

Inclusion criteria: all patients aged 18 and older with mechanical jaundice requiring surgical treatment.

Exclusion criteria: includes children and adolescents under 18 years of age, patients who do not agree to participate, incapacitated, pregnant women are excluded from the study. The total number of the sample was n=79 (100%) patients for the study, the patients were divided into 2 groups: the main group n = 35 (44.3%), patients who were treated with L-carnitine and the control group n=44 (55.7%). The prevention was based on a previously developed method of treating coagulopathies during surgery for mechanical jaundice, which includes a systemic effect on hemostasis and low invasiveness: treatment with levocarnitine at a dose of 5 ml intravenously slowly for 2-3 minutes, or drip in 100-200 ml of 0.9% sodium chloride.

Results: Changes in blood clotting parameters in patients with mechanical jaundice upon admission and on the 1st, 3rd and 5th days after treatment with the proposed method noticeably improve, so there is a shift in the indications APTT, Claus fibrinogen, INR and PT towards hypercoagulation already on day 1 (because they are specific markers of prolonged bleeding).

Conclusion: The proposed improved method of preventing coagulopathic bleeding during surgery for mechanical jaundice allowed to significantly reduce the incidence of coagulopathy in these patients, which is especially important, the frequency of their clinical manifestation, so Klausfibrinogen in the blood on the 5th day was 3.8 g/l, which turned out to be statistically significant U-412.500 (P=0.05) and improved PT by the 5th day was 12.3 seconds, the statistical significance of U was 208.500 (P=0.05).