A METHOD FOR PREVENTING COAGULOPATHIC BLEEDING DURING SURGERY FOR MECHANICAL JAUNDICE
Relevance: A pathological syndrome that develops as a result of impaired outflow of hepatic bile through the biliary tract into the intestine due to mechanical obstacles is called mechanical jaundice (MJ). Hemostasis depends on the full function of the liver, since the synthesis of many coagulation factors occurs in liver cells, and activation products occur in cells of the reticuloendothelial system of the liver. Violation of hemostasis directly depends on the severity of hepatocyte dysfunction. Such patients may develop disseminated intravascular coagulation (DIC) and bleeding during and after surgery.
Aim. To improve the results of treatment of coagulopathy bleeding during surgery for mechanical jaundice, through proactive therapy.
Materials and methods. Research design: A non-randomized clinically controlled trial. The state of hemostasis was studied depending on the duration of jaundice in 79 patients with mechanical jaundice treated at the University Hospital of the "Semey Medical University" NCJSC. Inclusion criteria: patients aged 18 and older with obstructive jaundice requiring surgical treatment. Exclusion criteria: children and adolescents under 18 years of age, patients who do not agree to participate, incapacitated, pregnant women. To conduct the study, the patients were divided into 2 groups: the main n = 35 (44.3%) patients who were treated with L-cornitine and the control group n = 44 (55.7%).
For statistical processing, the nonparametric Mann-Whitney criterion was applied when there were restrictions in the use of parametric analysis. To refute the null hypothesis, a statistical significance level of p < 0.05 was adopted.
Results: Changes in blood clotting indices in patients with mechanical jaundice upon admission and on the 1st, 3rd and 5th days after treatment with the proposed method noticeably improve, as there is a shift in the indications of APTT, Klaus fibrinogen, INR and PTT towards hypercoagulation already on the 1st day, (because they they are specific markers of ongoing bleeding).
Conclusion: The proposed improved method for the prevention of coagulopathic bleeding during surgery for mechanical jaundice made it possible to significantly reduce the incidence of coagulopathy in these patients, which is especially important, the frequency of their clinical manifestation, since Klaus fibrinogen in the blood on day 5 was 3,8 g/l, which turned out to be statistically significant U - 412,500 (P =0,05) and the PTT improved on the 5th day was 12,3 seconds, the statistical significance of U - 208,500 (P =0,05).
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Orazgalieva M.T., Aimagambetov M.J., Omarov N.B., Masalov A.E., Orazalina A.S., Akbayeva M.M., Muratkhanova Zh.M., Tleubaeva M.B. A method for preventing coagulopathic bleeding during surgery for mechanical jaundice // Nauka i Zdravookhranenie [Science & Healthcare]. 2024, (Vol.26) 1, pp. 109-117. doi 10.34689/SH.2024.26.1.014Related publications:
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