COMPLEX CORRECTION OF HEMORRHAGIC DISORDERS IN PATIENTS WITH GIANT UTERINE MYOMAS
Keywords:
giant uterine myoma, blood loss, fibrinolysisAbstract
Actuality. Intraoperative blood loss, can act as an aggravating factor during the perioperative period. Reduced blood loss is an urgent problem in patients with uterine cancer, which is planned surgery. The aim of the study was to reduce perioperative blood loss in patients with giant uterine myoma. Materials and methods. There examined the results of surgical treatment of 74 patients with a diagnosis of giant uterine myoma. Research conducted at the Department of Gynecology and Intensive Therapy Odessa Regional Hospital in 2010-2016. The average age of patients with uterine myoma was 48.31±5.65 years. Blood clotting system was investigated using low-frequency pyezoelectric thromboelastography. Patients were divided into two groups depending on the type of correction hemocoagulation disorders. 35 patients of 1 group received in complex correction epidural anesthesia at the level of L2-L3 7–12 ml of 0.5 % bupivacaine and 10 mL of 0. 5 % bupivacaine in the first postoperative day fractionally. Anticoagulant therapy was bemiparin 2500 IU in the first post-operative day and for 7 days after. Antifibrinolytic therapy in these patients has not been evaluated. 39 patients of second group had complex correction which included epidural anesthesia at the level of L2-L3 7–12 ml of 0.5 % bupivacaine and 10 mL of 0.5 % bupivacaine in the first postoperative day fractionally. Anticoagulant therapy was bemiparin 2500 IU in the first post-operative day and for 7 days after. Patients in this group was assigned tranexamic acid for 30 minutes prior to surgery in a dose of 20 mg/kg, and followed infusion — 5 mg/kg per hour for the first postoperative day. Statistical analysis was provided using the methods of parametric and non-parametric analysis (software Statistica 6.0 (StatSoft Inc., USA). Results. In the preoperative period in patients with giant uterine myomas was found activation of fibrinolysis, increasing of platelet aggregation and hypercoagulability. Patients with uterine cancer had structural and chronometric activation of vascular-platelet hemostasis with an increased generation of thrombin and the activation of the fibrinolytic activity of the blood. As a result of studies have provided evidence that the use of antifibrinolytic therapy as intravenous infusion of tranexamic acid for 30 minutes before the surgery in a dose of 20 mg/kg followed by infusion of 5 mg/ kg per hour for the first postoperative day, helped to reduce perioperative blood loss by 29 %. Hemoglobin level was higher by 10 % (p<0.05), blood loss was lower by 29 % (p<0.05), the length of stay in hospital was reduced by 24 % (p<0.05) in patients of the second group on the second postoperative day. Conclusions. Use of epidural anesthesia, tranexamic acid and bemiparin is the most appropriate to reduce blood loss and recovery of the hemostatic system capabilities. In patients with a hemoglobin level of the 2 group on the second postoperative day was higher by 10 % (p<0.05), blood loss was lower by 29 % (p<0.05), the need for transfusion of blood products decreased by 9.28 % (p<0.05), length of stay in intensive care was 24 % lower (p<0.05).
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