Transfuzijsko liječenje ortopedskih bolesnika

master's thesis

• Title (english): Blood management in orthopedic patients
• Author: Vjera Zgombić
• Mentor: Branko Tripković (mentor)
• Committee member: Slobodan Mihaljević (predsjednik povjerenstva)
• Committee member: DINKO TONKOVIĆ (član povjerenstva)
• Committee member: Branko Tripković (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Ortopedski kirurški zahvati uključuju resekcije kosti i okolnih dobro vaskulariziranih tkiva. Kod ovih operacijskih zahvata standardne metode hemostaze kao kauterizacija i podvezivanje krvnih žila često nisu moguće te dolazi do značajnih perioperativnih krvarenja. Pri ugradnji revizijskih endoproteza kuka pacijent može izgubiti do 4000 mL krvi. Transfuzijsko liječenje često je indicirano, a strah od prijenosa zaraznih bolesti krvlju i imunoloških reakcija te porast cijena krvnih pripravaka doveli su do razvoja alternativnih metoda transfuzije. Ovaj pregledni rad govori o metodama transfuzijskog liječenja ortopedskih bolesnika pri kojima se nastoji smanjiti perioperacisjko krvarenje i potrošnja krvnih pripravaka. Ove metode uključuju postupke prijeoperacijske autologne donacije, akutne normovolemične hemodilucije, intraoperacijske i poslijeoperacijske autotransfuzije te farmakološke metode primjene eritropoetina i antifibrinolitika. Brojne studije pokazale su da primjena autotransfuzijskih metoda značajno smanjuje učestalost alogeničnih transfuzija i pozitivno utječe na klinički ishod, no još se raspravlja o troškovima i isplativosti ovakvog liječenja. Bolji rezultati zabilježeni su prilikom pridržavanja restriktivnih kriterija za transfuzijsko liječenje, a važna je i prijeoperacijska procjena i korekcija anemije. Za najbolje rezultate važno je odabrati optimalnu metodu za svakog pacijenta uz usavršavanje kirurške tehnike i anesteziološkog pristupa.

Abstract (english)

Orthopedic procedures involve dissection through bone and vascular tissues, where hemostasis by ligature and cauterization isn't possible, resulting in significant blood loss. Patients undergoing revision hip replacement can lose up to 4000 mL of blood. Because of this transfusions are often necessary in orthopedic patients. The risks of bloodborne infections and immune reactions along with the increasing costs of blood products prompted the development of alternatives to allogeneic blood. This review covers procedures like preoperative autologous donation, acute normovolemic hemodilution, intraoperative cell salvage and postoperative reinfusion and pharmacological measures such as erythropoietin treatment and antifibrinolytic drugs. The reports from numerous clinical trials show that these methods of autologous transfusion reduce allogeneic transfusion rates and improve clinical outcomes but there are concers about their efficacy and cost-effectivness. Studies have also shown that adherence to restrictive transfusion strategies and management of preoperative anaemia decrease the need for blood transfusions in orthopedic patients. Choosing the appropriate method for each patient, anesthetic management and surgical technique are all important for minimising allogeneic blood transfusions.

• Keywords: artroplastika; krvarenje; autologna transfuzija; eritropoetin; antifibrinolitici
• Keywords (english): arthroplasty; blood loss; blood conservation; autologous transfusion; erythropoietin; antifibrinolytic drugs
• Language: croatian
• URN:NBN: urn:nbn:hr:105:241144
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-07-07 08:44:51