EFFECT OF EPIDURAL ANALGESIA ON THE HEMOCOAGULATION SYSTEM STATE IN PATIENTS WITH ACUTE DESTRUCTIVE PANCREATITIS
Keywords:
acute destructive pancreatitis, hemostasis, epidural anesthesiaAbstract
Background. Changes in hemostasis following acute destructive pancreatitis (ADP) are directed towards its activation and antihemostatic activity, occurs in the later stages of the ADP and is associated with the development of DIC. Aim. To improve the results of ADP intensive therapy by the complex correction of the blood aggregation regulation system. Materials and methods. The study included 60 patients with ADP, were divided into 2 groups. Patients of the 1 group (control) — 30 patients, received opioid analgesia (promedol, fentanyl) in combination with non-steroidal anti-inflammatory drugs (NSAIDs) for conservative therapy. The patients of 2nd group (30 patients) had analgesia by epidural administration of local anesthetic in combination with the NSAID during conservative therapy. Hemostatic system was evaluated at 1 and 3 days with the help by low-frequency pyezoelectric thromboelastography (LPTEG). Results. LPTEG indicators characterizing the state of the hemostatic system in patients with ADP from the start of treatment had significant differences from normal values. According to LPTEG patients of 1 group had statistically significant enhancement and acceleration of platelet aggregation, inhibition of fibrinolysis and increased coagulation activity, that persist on the 3rd day of treatment. On the 3rd day of treatment the 2nd group patients had positive dynamics of the hemostatic system, with a tendency to normalization of aggregation and fibrinolysis.
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