Total Diz Artroplastisinde Cerrahi Yara Kapatılması Öncesinde Kontrollü Arteriyel Hipertansiyon ile Yapılan Hemostazis Kanama Miktarını ve Transfüzyon İhtiyacını Etkiler mi?

Öz

Amaç: Total diz artroplastisinde (TDA) cerrahi yaranın kapatılmasından önce kontrollü olarak arttırılan arteriyel kan basıncı ile yapılan hemostazisin etkinliğinin değerlendirilmesi amaçlanmıştır. Materyal ve Metot: Veriler hipotansif epidural anestezi (HEA) ile TDA ameliyatı olmuş 87 hastanın (65 kadın, 25 erkek) tıbbi kayıtlarından retrospektif olarak toplanmıştır. Hastalar cerrahi yaranın kapatılmasından önce kontrollü arteriyel hipertansiyon uygulanmasına göre iki gruba ayrılmıştır. Grup I (n:44) HEA uygulanan hastaları, grup II (n:43) cerrahi yara kapatılmasından önce kontrollü arteriyel hipertansiyon (operasyon öncesindeki ortalama arteriyel kan basıncından daha yüksek) uygulanan hastaları içermektedir. Temel tanımlayıcılar olarak peroperatif hemoglobin ve hematokrit seviyeleri, sistolik ve diasitolik kan basıncı, transfüze edilen eritrosit süspansiyonu miktarları iki grup arasında kıyaslanmıştır. Bulgular: Gruplardaki ortalama yaş 66,41+6,17 (57-78) dir. Operasyon sonrası 1.(p=0,031), 2.(p=0,032), 4.(p=0,001), 12.(p=0,001), 24.(p=0,001) saatlerdeki kanama miktarı grup II de anlamlı olarak daha düşüktü (Sırasıyla, p=0.031, 0.032, 0.001, 0.001, 0.001). Komplikasyon, cerrahi süre, peroperatif kanama, hastanede yatış ve takip süresi, peroperatif hemoglobin değeri, transfüze edilen eritrosit süspansiyonu miktarı ile peroperatif sistolik-diasitolik kan basıncı değerleri açısından gruplar arasında istatistiksel bir fark yoktu. Sonuç: Bulgularımız TDA’da cerrahi yara kapatılması öncesinde ortalama arteriyel kan basıncının kontrollü olarak yükseltilmesinin daha ayrıntılı bir şekilde kanama kontrolü yapılmasına olanak verdiğini göstermektedir. Bizim bu şekildeki ilk bulgularımızı daha büyük vaka serilerinde yapılan prospektif, randomize, kontrollü çalışmalar destekleyecektir.

Anahtar Kelimeler

• Kanama
• hemostazis
• hipotansif epidural anestezi
• kontrollü hipertansiyon
• total diz artroplastisi

Does Hemostasis with Controlled Arterial Hypertension Before Surgical Wound Closure in Total Knee Arthroplasty Affect the Amount of Bleeding and Transfusion Need?

Abstract

Objective: We aimed to assess the efficacy of hemostasis while controlled augmentation of arterial blood pressure before surgical closure after total knee arthroplasty (TKA). Materials and Methods: This retrospective cohort involved data collected from the medical files of 87 patients (62 women, 25 men) who underwent TKA using hypotensive epidural anesthesia (HEA). Patients were allocated into two groups. Group I (n=44) received HEA, while Group II (n=43) had controlled arterial hypertension before surgical closure. Perioperative hemoglobin and hematocrit levels, systolic and diastolic blood pressure, and the amount of erythrocyte suspension transfusion were compared between the two groups. Results: The average age of our series was 66.41 ± 6.17 (range: 57-78) years. Notably, the amount of bleeding on postoperative 1st, 2nd, 4th, 12th, and 24th (p=0.031, 0.032, 0.001, 0.001, 0.001, respectively) hours was significantly less in Group II. There were no significant differences between the two groups for complications, operative duration, perioperative bleeding, duration of follow-up and hospitalisation, and compared descriptives. Conclusion: Our data indicated that controlled elevation of mean arterial pressure before surgical closure might allow the achievement of meticulous hemostasis after TKA. Further prospective, randomised, controlled trials on more extensive series are warranted to verify our preliminary results.

Keywords

• Bleeding
• controlled hypertension
• hypotensive epidural anesthesia
• hemostasis
• total knee arthroplasty

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