کاهش خون‌ریزی حین عمل فیوژن خلفی ستون فقرات با تجویز فیبرینوژن

پورنجفیان, علیرضا; قدرتی, محمدرضا; محسنی, مسعود; قمری, علی اکبر; صادقی, فرحناز

کاهش خون‌ریزی حین عمل فیوژن خلفی ستون فقرات با تجویز فیبرینوژن

نوع مقاله : مقاله های پژوهشی

نویسندگان

¹ استادیار، گروه بیهوشی، مرکز آموزشی درمانی فیروزگر، دانشگاه علوم پزشکی ایران، تهران، ایران

² دانشیار، گروه بیهوشی، مرکز آموزشی درمانی فیروزگر، دانشگاه علوم پزشکی ایران، تهران، ایران

³ استادیار، گروه بیهوشی، بیمارستان رسول اکرم (ص)، دانشگاه علوم پزشکی ایران، تهران، ایران

⁴ دستیار، گروه بیهوشی، دانشکده‌ی پزشکی و مرکز آموزشی درمانی فیروزگر، دانشگاه علوم پزشکی ایران، تهران، ایران

چکیده

مقدمه: جراحی‌های ستون فقرات اغلب با میزان بالایی از خون‌ریزی حین و پس از عمل همراه است. پیشتر نشان داده شده است که سطح فیبرینوژن سرم، عامل تعیین کننده‌ی میزان خون‌ریزی حین یا پس از عمل می‌باشد. هدف از این مطالعه، بررسی تأثیر انفوزیون پروفیلاکتیک فیبرینوژن در بیماران کاندید فیوژن خلفی ستون فقرات از نظر جلوگیری از خون‌ریزی بود.روش‌ها: در مجموع، 41 بیمار کاندید فیوژن خلفی ستون فقرات به طور تصادفی به دو گروه تقسیم شدند و پس از القای بیهوشی، یک گرم فیبرینوژن (گروه مداخله، شامل 21 بیمار) یا دارونما (گروه شاهد، شامل 20 بیمار) به صورت وریدی دریافت کردند. تغییرات سطح سرمی هموگلوبین و فیبرینوژن، میزان خون‌ریزی حین عمل و میزان نیاز به ترانسفوزیون خون، در دو گروه مقایسه شد.یافته‌ها: در حالی که تغییرات سطح سرمی هموگلوبین و فیبرینوژن قبل و پس از عمل در دو گروه تفاوت آماری نداشت، متوسط میزان حجم خون از دست رفته (9/157 ± 3/533 در برابر 0/130 ± 0/679 میلی‌لیتر، 003/0 = P) و میزان نیاز به ترانسفوزیون خون (0 در برابر 30 درصد، 030/0 = P) در گروه شاهد به طور معنی‌داری بیشتر بود.نتیجه‌گیری: انفوزیون پروفیلاکتیک فیبرینوژن در بیماران کاندید فیوژن خلفی ستون فقرات، به طور معنی‌داری میزان خون‌ریزی حین عمل و میزان نیاز به ترانسفوزیون خون را کاهش می‌دهد.

کلیدواژه‌ها

عنوان مقاله [English]

Reduction of Intraoperative Bleeding with Fibrinogen Administration in Posterior Spinal Fusion Surgery

نویسندگان [English]

Alireza Pournajafian ¹
Mohammadreza Ghodraty ²
Masood Mohseni ³
Ali Akbar Ghamari ⁴
Farahnaz Sadeghi ⁴

¹ Assistant Professor, Department of Anesthesiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran

² Associate Professor, Department of Anesthesiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran

³ Assistant Professor, Department of Anesthesiology, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

⁴ Resident, Department of Anesthesiology, School of Medicine AND Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran

چکیده [English]

Background: Spinal surgeries are frequently complicated with high rate of intra- and post-operative hemorrhage. It is shown that the serum fibrinogen level is a pivotal factor in determining the degree of intra- and post-operative hemorrhage. This study sought to examine the effect of prophylactic infusion of fibrinogen in preventing hemorrhage in candidates for posterior spinal fusion surgery.Methods: 41 patients who were candidates for posterior spinal fusion surgery were randomly devided in two groups of intervention (21 patients) and control (20 patients), receiving either infusion of fibrinogen (1 g in 100 cc of normal saline infused within 5 minutes after induction) or placebo, respectively. Changes in serum hemoglobin and fibrinogen, the severity of intraoperative hemorrhage, and the need for blood transfusion were compared between the two groups. Findings: While pre- and postoperative changes in serum hemoglobin and fibrinogen did not differ significantly between the two groups, the mean blood loss (533.3 ± 157.9 vs. 679.0 ± 130.0 ml, P = 0.003) and the need for blood transfusion (0 vs. 30 percent, P = 0.030) were significantly higher in the control group.Conclusion: Prophylactic infusion of fibrinogen in candidates for posterior spinal fusion surgery may significantly decrease the amount of intra-operative hemorrhage and the need for blood transfusion.

کلیدواژه‌ها [English]

Fibrinogen
Hemorrhage
Posterior spinal fusion surgery

مراجع

Smorgick Y, Baker KC, Bachison CC, Herkowitz HN, Montgomery DM, Fischgrund JS. Hidden blood loss during posterior spine fusion surgery. Spine J 2013; 13(8): 877-81.
Irita K. Risk and crisis management in intraoperative hemorrhage: Human factors in hemorrhagic critical events. Korean J Anesthesiol 2011; 60(3): 151-60.
Irita K. Present status of critical hemorrhage and its management in the operating room. Rinsho Byori 2014; 62(12): 1275-9.
Yang L, Vuylsteke A, Gerrard C, Besser M, Baglin T. Postoperative fibrinogen level is associated with postoperative bleeding following cardiothoracic surgery and the effect of fibrinogen replacement therapy remains uncertain. J Thromb Haemost 2013; 11(8): 1519-26.
McQuilten ZK, Crighton G, Engelbrecht S, Gotmaker R, Brunskill SJ, Murphy MF, et al. Transfusion interventions in critical bleeding requiring massive transfusion: a systematic review. Transfus Med Rev 2015; 29(2): 127-37.
Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu DC, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 2013; 30(6): 270-382.
Yuan L, Bao NR, Zhao JN. Progress on hidden blood loss after hip replacement. Zhongguo Gu Shang 2015; 28(4): 378-82. [In Chinese].
Iorio J, Bennett JT, Orlando G, Singla A, Dakwar E, Bonet H, et al. Does Amicar affect blood loss in patients with adolescent idiopathic scoliosis treated with pedicle screws and Ponte osteotomies? Surg Technol Int 2013; 23: 291-5.
Dhawale AA, Shah SA, Sponseller PD, Bastrom T, Neiss G, Yorgova P, et al. Are antifibrinolytics helpful in decreasing blood loss and transfusions during spinal fusion surgery in children with cerebral palsy scoliosis? Spine (Phila Pa 1976) 2012; 37(9): E549-E555.
Samdani AF, Torre-Healy A, Asghar J, Herlich AM, Betz RR. Strategies to reduce blood loss during posterior spinal fusion for neuromuscular scoliosis: a review of current techniques and experience with a unique bipolar electrocautery device. Surg Technol Int 2008; 17: 243-8.
Thompson GH, Florentino-Pineda I, Armstrong DG, Poe-Kochert C. Fibrinogen levels following Amicar in surgery for idiopathic scoliosis. Spine (Phila Pa 1976) 2007; 32(3): 368-72.
Aawar N, Alikhan R, Bruynseels D, Cannings-John R, Collis R, Dick J, et al. Fibrinogen concentrate versus placebo for treatment of postpartum haemorrhage: study protocol for a randomised controlled trial. Trials 2015; 16: 169.
Karlsson M, Ternstrom L, Hyllner M, Baghaei F, Skrtic S, Jeppsson A. Prophylactic fibrinogen infusion in cardiac surgery patients: effects on biomarkers of coagulation, fibrinolysis, and platelet function. Clin Appl Thromb Hemost 2011; 17(4): 396-404.
Karlsson M, Ternstrom L, Hyllner M, Baghaei F, Flinck A, Skrtic S, et al. Prophylactic fibrinogen infusion reduces bleeding after coronary artery bypass surgery. A prospective randomised pilot study. Thromb Haemost 2009; 102(1): 137-44.
Huissoud C, Carrabin N, Audibert F, Levrat A, Massignon D, Berland M, et al. Bedside assessment of fibrinogen level in postpartum haemorrhage by thrombelastometry. BJOG 2009; 116(8): 1097-102.
Charbit B, Mandelbrot L, Samain E, Baron G, Haddaoui B, Keita H, et al. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage. J Thromb Haemost 2007; 5(2): 266-73.
Shibata Y, Shigemi D, Ito M, Terada K, Nakanishi K, Kato M, et al. Association between fibrinogen levels and severity of postpartum hemorrhage in singleton vaginal deliveries at a Japanese perinatal center. J Nippon Med Sch 2014; 81(2): 94-6.
Hannon M, Quail J, Johnson M, Pugliese C, Chen K, Shorter H, et al. Fibrinogen and prothrombin complex concentrate in trauma coagulopathy. J Surg Res 2015; 196(2): 368-72.
Levy JH, Goodnough LT. How I use fibrinogen replacement therapy in acquired bleeding. Blood 2015; 125(9): 1387-93.
Davenport R. Coagulopathy following major trauma hemorrhage: lytic, lethal and a lack of fibrinogen. Crit Care 2014; 18(3): 151.
Carling MS, Jeppsson A, Wessberg P, Henriksson A, Baghaei F, Brisby H. Preoperative fibrinogen plasma concentration is associated with perioperative bleeding and transfusion requirements in scoliosis surgery. Spine (Phila Pa 1976) 2011; 36(7): 549-55.
Koster T, Rosendaal FR, Reitsma PH, van der Velden PA, Briet E, Vandenbroucke JP. Factor VII and fibrinogen levels as risk factors for venous thrombosis. A case-control study of plasma levels and DNA polymorphisms--the Leiden Thrombophilia Study (LETS). Thromb Haemost 1994; 71(6): 719-22.
Miller RD. Transfusion therapy. In: Miller RD, Eriksson LI, Fleisher L, Wiener-Kronish JP, Young WL. Miller's anesthesia. 7th ed. New York, NY: Churchill Livingstone; 2010. p. 1739-44.
Ucar HI, Oc M, Tok M, Dogan OF, Oc B, Aydin A, et al. Preoperative fibrinogen levels as a predictor of postoperative bleeding after open heart surgery. Heart Surg Forum 2007; 10(5): E392-E396.
Blome M, Isgro F, Kiessling AH, Skuras J, Haubelt H, Hellstern P, et al. Relationship between factor XIII activity, fibrinogen, haemostasis screening tests and postoperative bleeding in cardiopulmonary bypass surgery. Thromb Haemost 2005; 93(6): 1101-7.
Rahe-Meyer N, Pichlmaier M, Haverich A, Solomon C, Winterhalter M, Piepenbrock S, et al. Bleeding management with fibrinogen concentrate targeting a high-normal plasma fibrinogen level: a pilot study. Br J Anaesth 2009; 102(6): 785-92.
Solomon C, Pichlmaier U, Schoechl H, Hagl C, Raymondos K, Scheinichen D, et al. Recovery of fibrinogen after administration of fibrinogen concentrate to patients with severe bleeding after cardiopulmonary bypass surgery. Br J Anaesth 2010; 104(5): 555-62.
Solomon C, Schochl H, Hanke A, Calatzis A, Hagl C, Tanaka K, et al. Haemostatic therapy in coronary artery bypass graft patients with decreased platelet function: comparison of fibrinogen concentrate with allogeneic blood products. Scand J Clin Lab Invest 2012; 72(2): 121-8.
Schochl H, Cotton B, Inaba K, Nienaber U, Fischer H, Voelckel W, et al. FIBTEM provides early prediction of massive transfusion in trauma. Crit Care 2011; 15(6): R265.
Rourke C, Curry N, Khan S, Taylor R, Raza I, Davenport R, et al. Fibrinogen levels during trauma hemorrhage, response to replacement therapy, and association with patient outcomes. J Thromb Haemost 2012; 10(7): 1342-51.
Thorarinsdottir HR, Sigurbjornsson FT, Hreinsson K, Onundarson PT, Gudbjartsson T, Sigurdsson GH. Effects of fibrinogen concentrate administration during severe hemorrhage. Acta Anaesthesiol Scand 2010; 54(9): 1077-82.
Wafaisade A, Lefering R, Maegele M, Brockamp T, Mutschler M, Lendemans S, et al. Administration of fibrinogen concentrate in exsanguinating trauma patients is associated with improved survival at 6 hours but not at discharge. J Trauma Acute Care Surg 2013; 74(2): 387-3.