COMPARATIVE CHARACTERISTICS OF CHANGES IN THE HEMOSTATIC SYSTEM IN PATIENTS WITH A DIFFERENT CHANCE OF DEVELOPING FAT EMBOLISM SYNDROME USING THE METHOD OF LOW-FREQUENCY PIEZOELECTRIC THROMBOELASTOGRAPHY
DOI:
https://doi.org/10.31379/2411.2616.16.2.10Keywords:
LPTEG, polytrauma, fat embolism syndrome, coagulopathy.Abstract
Introduction. Politrauma takes one of the leading positions among the causes of death of the adult working population. Complex combined injuries of the musculoskeletal system may be accompanied by an embolism of lipid globules, which, in turn, play a role in the activation of the vascular-platelet link of hemostasis. In the presence of a sufficient size of lipid globules, the development of the fat embolism syndrome (FES) is possible in the future, however, clinical manifestation of the aforementioned condition does not always occur. Aim. The aim of the study is to compare changes in the hemostatic system in patients with different chances of developing FES using the method of low-frequency piezoelectric thromboelastography (LPTEG). Materials and methods. The state of the system of regulation of the state of aggregation of blood was evaluated in a group of 72 patients with a diagnosis of polytrauma on the third day of their stay in the general intensive care unit of the Odessa Regional Clinical Hospital. Changes were assessed using LPTEG: in group A (n = 38) without clinical signs of FES and with a prognostic evaluation of the development of FES according to Borisov ≤5 points at the time of admission; in group B (n = 34), without clinical signs of FES and with a prognostic assessment of the development of FES according to Borisov ≤10 points at the time of admission; the control group (n = 20) was composed of healthy donors who underwent LPTEG. Results. LPTEG in patients of groups A and B shows no significant difference (p <0.05). The presence of activation of the vascular-platelet link of hemostasis, significant structural and chronometric hypercoagulation with increased thrombin generation and activation of blood fibrinolytic activity are noted in both groups. The research results demonstrate a group of patients with polytrauma as a cohort in which there are profound disorders of the regulation system of the state of aggregation of blood. Conclusions. The method of low-frequency piezoelectric thromboelastography demonstrates the absence of statistically significant changes in the hemostasis system for patients with polytrauma and different prognostic assessment of the development of ES according to Borisov at the time of admission. These studies should be taken into account when: developing protocols for managing patients with coagulation disorders in polytrauma; stratification of risk of PVC development and choice of optimal therapy in patients with polytrauma; optimization of pharmacological and non-pharmacological correction of the RASK system.
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