urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/2071-5943-2023-22-5-87-94urmj-1333Research ArticleОригинальные статьи | Original articlesOriginal articlesОценка состояния системы плазменного гемостаза в раннем послеоперационном периоде у пациентов после абдоминопластикиAssessment of plasma hemostasis system in the early postoperative period in patients after abdominoplastyКузьминВ. В.KuzminV. V.

Вячеслав Валентинович Кузьмин, доктор медицинских наук, профессор кафедры анестезиологии, реаниматологии, токсикологии

Екатеринбург

Vjacheslav V. Kuzmin, Doctor of Science (Medicine), Professor of the Department of Anesthesiology, Reanimatology, Toxicology

Ekaterinburg

eugkh@yandex.ruГолубковН. А.GolubkovN. N.

Николай Александрович Голубков, кандидат медицинских наук, ассистент кафедры хирургических болезней, сердечно-сосудистой хирургии, реконструктивной и пластической хирургии

Екатеринбург

Nikolaj N. Golubkov, PhD (Medicine), Assistant of the Department of Surgical Diseases, Cardiovascular Surgery, Reconstructive and Plastic Surgery

Ekaterinburg

golubkov.plastic-surgery@mail.ruЧернядьевС. А.ChernyadyevS. A.

Сергей Александрович Чернядьев, доктор медицинских наук, профессор, заведующий кафедрой хирургических болезней, сердечно- сосудистой хирургии, реконструктивной и пластической хирургии

Екатеринбург

Sergej A. Chernyadyev, Doctor of Science (Medicine), Professor, Head of the Department of Surgical Diseases, Cardiovascular Surgery, Reconstructive and Plastic Surgery

Ekaterinburg

chsa-surg@mail.ruСолодушкинС. И.SolodushkinS. I.

Святослав Игоревич Солодушкин, кандидат физико-мататематических наук, доцент кафедры вычислительной математики

Екатеринбург

Svjatoslav I. Solodushkin, PhD (Physics and Mathematics), Associate Professor of the Department of Computational Mathematics

Ekaterinburg

s.i.solodushkin@urfu.ruУральский государственный медицинский университетРоссияUral State Medical UniversityRussian FederationУральский федеральный университет имени первого Президента России Б.Н. ЕльцинаРоссияUral Federal University named after the first President of Russia B.N. YeltsinRussian Federation2023271020232258794Copyright © Кузьмин В.В., Голубков Н.А., Чернядьев С.А., Солодушкин С.И., 20232023Кузьмин В.В., Голубков Н.А., Чернядьев С.А., Солодушкин С.И.Kuzmin V.V., Golubkov N.N., Chernyadyev S.A., Solodushkin S.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1333Введение

Введение. Венозные тромбоэмболические осложнения после абдоминопластики связывают с повышением внутрибрюшного давления и изменением венозного возврата без учета возможного изменения активности свертывающей системы крови.

Цель работы – оценить состояние системы плазменного гемостаза в раннем послеоперационном периоде у пациентов после абдоминопластики.

Материалы и методы

Материалы и методы. В исследование включено 100 пациентов, которым была проведена эстетическая абдоминопластика. Оценивали уровень протромбина (ПТ), фибриногена (ФГ), активированное частичное тромбопластиновое время (АЧТВ), концентрацию растворимых фибрин-мономерных комплексов (РФМК), лизис эуглобулинового сгустка (ЛЭС), антитромбин-III (АТ-III) и протеин С (ПрС) до операции, сразу после операции, на первые, третьи и пятые сутки после операции. Статистический анализ данных проводили с использованием пакета прикладных программ SPSS 16, Excel 2010 для Windows с использованием критерия Краскала – Уоллиса.

Результаты

Результаты. Коагуляционный гемостаз характеризовался снижением ПТ сразу после операции и в первые сутки на 13,9 и 5,3, и повышением ПТ на третьи и на пятые сутки на 12,3 и 15,5 (p < 0,001); снижением ФГ сразу после операции на 0,5 г/л и увеличением ФГ на первые, третьи и пятые сутки на 0,49, 2,34 и 2,04 г/л (p < 0,001); увеличением РФМК на всех послеоперационных этапах в 4,8, 8,2, 10,8 и 10,0 раз (p < 0,001). Торможение XII-а зависимого фибринолиза характеризовалось увеличением продолжительности времени ЛЭС на первые, третьи и пятые сутки на 2,8, 9,7 и 6,3 минут соответственно (p < 0,001). Уровень АТ-III и ПрС снижался сразу после операции на 18,8 и 8,9, на первые сутки – на 14,2 и 11,2, на третьи сутки – на 8,8 и 6,3 (p < 0,001).

Обсуждение

Обсуждение. Активация процессов свертывания крови с дисбалансом свертывающей, противосвертывающей и фибринолитической систем создают условия для образования венозных тромбозов после абдоминопластики, что обосновывает необходимость фармакопрофилактики венозной тромбоэмболии не менее пяти суток.

Заключение

Заключение. В раннем послеоперационном периоде абдоминопластика сопровождается активацией плазменной коагуляции, торможением активности фибринолитической системы и уменьшением активности естественных антикоагулянтов.

Introduction Venous thromboembolic complications after abdominoplasty are associated with increased intraabdominal pressure and altered venous return without taking into account possible changes in the activity of the blood coagulation system.

Purpose of work was to evaluate the state of the plasma hemostasis system in the early postoperative period in patients after abdominoplasty.

Materials and methods The study included 100 patients who underwent aesthetic abdominoplasty. Prothrombin (PT), fibrinogen (FG), activated partial thromboplastin time (APTT), soluble fibrin-monomer complexes (SFMC), euglobulin clot lysis (ECL), antithrombin-III (AT-III), and protein C (PrC) levels were evaluated before surgery, immediately after surgery, on the first, third and fifth days after surgery. Statistical data analysis was performed using SPSS 16, Excel 2010 for Windows, using the Kruskal – Wallis criterion.

Results Coagulation hemostasis was characterized by a decrease in PT immediately after the surgery and on the first day by 13.9 and 5.3, and an increase in PT on the third and fifth days by 12.3 and 15.5 (p < 0.001), decrease in FG on the first, third and fifth days by 0.49 g/L, 2.34 g/L, and 2.04 g/L, respectively (p < 0.001). SFMC increased at all postoperative stages by 4.7, 8.2, 10.8, and 10.0 times (p < 0.001). Inhibition of XII-dependent fibrinolysis was characterized by an increase in ECL time on the first, third and fifth days by 2.8, 9.7, and 6.3 minutes, respectively (p < 0.001). AT-III and PrC levels decreased immediately after the surgery by 18.8 and 8.9, on the first day by 14.2 and 11.2, and on the third day by 8.8 and 6.3 respectively (p < 0.001).

Discussion Activation of blood coagulation processes with imbalance of coagulation, anticoagulation, and fibrinolytic systems create conditions for venous thrombosis formation after abdominoplasty, which substantiates the necessity of VTE pharmacoloprophylaxis for at least five days.

Conclusion In the early postoperative period abdominoplasty is accompanied by activation of plasma coagulation, inhibition of fibrinolytic system activity and reduction of natural anticoagulant activity. 

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The authors declare that there are no conflicts of interest present.