Uticaj sistema za vantelesni krvotok na sistemski inflamatorni odgovor i funkciju trombocita kod pacijenata koji se podvrgavaju revaskularizaciji miokarda

Abstract

Although surgical revascularization of the myocardium is routine and one of the most performed procedures in cardiac surgery, complications that occur during and after surgery, such as systemic inflammation and sepsis, as well as bleeding due to impaired platelet function, have a high share in such high mortality. The extracorporeal bloodstream system has a special role in these processes. Determination of levels of new biomarker for detection infectious complications - presepsin, with CRP and leukocyte formula, is just one of these diagnostic combinations of tests that allow assessment of the immune status of a cardiac patient and the need for further examination and / or therapy of patients who may potentially develop systemic inflammatory response syndrome (SIRS) or sepsis. On the other hand, the application of aggregometry gives precise data on the functional changes of platelets, which enables adequate care of complications in terms of increased postoperative bleeding or thrombosis. The study included 100 patients of both sexes, 22 women (21.6%) and 78 men (76.5%), mean age 64.63 ± 7.48 years. Patients were divided into two groups in relation to the use of extracorporeal blood circulation device. Postoperatively, there was a decrease in the number of erythrocytes (p <0.001), hemoglobin (p <0.001), hematocrit (p <0.001), platelet count (p <0.001), ADP HS (p <0.001) and ASPI (p <0.05)test), and increases in the number of leukocytes (p <0.001) and the concentration of CRP (p <0.001) and presepsin (p <0.001 in the group of patients with ECC, with statistical significance of p <0.001 for all measured variables.The average perioperative blood loss was 1250 (1100.0-1700.0) ml, and there was no statistically significant difference between patients with and without EKK (Z = 1,653, p = 0,098) Serious bleeding (> 1800ml) was present in 15 patients (15 in the group where the extracorporeal circulatory system was applied, 17.64% of patients (9/51) met the clinical criteria for SIRS with elevated presepsin values of 600 pg / ml and more, while in the second group of patients 2 of 49 (4.08%) met the clinical and laboratory criteria for SIRS.The ECC system significantly affects the development of SIRS and inhibition of platelet function in patients where it was applied during surgery.