INFUSION AND TRANSFUSION THERAPY STRATEGIES FOR MASSIVE POSTPARTUM HEMORRHAGE
Аннотация
A prospective double-blind randomized controlled clinical trial was conducted in 115 parturient women and maternity patients (Group I – 57, Group II – 58) during obstetric operations for placenta increta at 37–38 weeks gestation. The risk of anesthesia is ASA II. As an anesthetic aid, spinal anesthesia at the level of L<sub>II</sub>–L<sub>IV</sub> was used in the groups, using a 0.5% solution of Longocaine Heavy as an adjuvant of Quanadex 10 mcg. As a preinfusion, a crystalloid solution of 15-20 ml/kg was injected into the Group I, a balanced polyelectrolyte hyperosmolar crystalloid solution of 10-15 ml/kg was injected into the Group II. At the stages of the operation, crystalloids and blood components were additionally injected. The central hemodynamics, pH, blood electrolytes, lactate, glucose and hematocrit were studied on Wondfo Blood Gas Analyser BGA-102 (Rain Sen Da). Brain natriuretic peptide prohormone (NT-proBNP), Cystatin C, S100ß protein were determined on the Finecare™ FIA Meter Plus FS 113 immunofluorescence analyzer (Wonfo). Newborns were evaluated on the Apgar scale and the S100ß protein on Finecare™ FIA Meter Plus FS 113 (Wonfo). Renal function was assessed based on urea, serum creatinine, glomerular filtration rate (Cystatin C), and Finecare™ FIA Meter Plus FS 113 (Wonfo) microalbumin. The hemostasis system was studied on the OCG-102 optical coagulometer (Wonfo) (Point-of-care Testing). Studies have shown that the use of low-volume infusion therapy in patients with suspected massive blood loss stabilizes the hemodynamic profile and CSF, creates moderate autohemodilation, without the development of dilution coagulopathy. Patients who received high volume infusion therapy had a significant increase in NT-proBNP more than 3 times the baseline values and showed acute kidney injury (AKI) already in the early stages of the study, with maximum manifestation by the end of the first day. For the early diagnosis and treatment of AKI, the study of microalbumin and and GFR with Cystatin C is recommended. Spinal anesthesia with hyperbaric Longocaine Heavy solution in combination with Quanadex is a safe option for anesthesia in patients without severe massive blood loss during cesarean section.