PLACE OF SPINAL ANESTHESIA IN A COMPLEX OF PREVENTIVE MEASURES FOR THROMBOTIC COMPLICATIONS IN PATIENTS WITH SEVERE PREECLAMPSIA
Keywords:
Amid sympathetic block is a statistically significant decline in hemoviscosimetry characterizing vascular-platelet hemostasis and coagulation level. Key words: pregnancy, hemostasis, preeclampsia, spinal anesthesiaAbstract
Background. Improving the efficiency of treatment of thrombotic complications in pregnant women and mothers with severe preeclampsia. Methods. The study was conducted in 59 patients with severe preeclampsia at gestational age 28–36 weeks at the Odessa Regional Perinatal Center. All pregnant women had operative delivery (urgency category 2) under spinal anesthesia 0.5 % solution of bupivacaine (omnicaine) at a dosage of 12 to 15 mg after previous infusion load 400–800 ml of crystalloids. Postoperative prevention with bemiparin was carried out in 12 hrs after the operation at a dosage of 2500 IU 1 time per day. Hemostatic system was investigated by low-frequency vibration of piezoelectric hemoviscosimetry before and during cesarean section. Results. During spinal anesthesia it is statistically significant (p<0.05) decreased the intensity of vascular-platelet hemostasis level in all study groups. These are the decrease in the intensity of the contact phase of coagulation (ICC) and the extension of the contact phase of coagulation interval (T1). In the analysis of the indicators characterizing coagulation (second) phase of hemostasis observed statistically significant (p<0,05) decrease their values: ICC reduced by 19 %, CTA — by 20 %, ICD — by 25 %. Density and the rate of fibrin clot parameters characterizing MA, IPC, ITC. The maximum amplitude (MA) represents the density of the formed clot. Against the background of sympathetic block was a statistically significant reduction (p<0,05) MA indicator by 20 %. However, the slowdown in fibrine formation block explains a significant decrease in IPC (p<0,05). The intensity of the total coagulation (ITC) describes the density of plateletfibrin clot structure, integrative interaction of all components involved in the formation of a clot. Statistically significant reduction ITC (p<0.05) during spinal anesthesia due to several changes that occur as a result of sympathetic block: reducing platelet aggregation, improve microcirculation, slowing the speed prothrombin and thrombosis formation.
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