Trombosit Belirteçlerinin Vertebra Cerrahisinde İntraoperatif Kanama Miktarı Tahminindeki Etkinliği

Abstract

AMAÇ: Perioperatif kanama yönetiminde en önemli basamaklardan birisi risk altındaki hastanın önceden belirlenmesidir. Major bir cerrahi olan vertebra cerrahisinde herhangi bir hemostatik anormallik olmasa bile ciddi kanamayla karşılaşılabilmekte ve perioperatif çok sayıda kan transfüzyonu gerekebilmektedir. Literatürde bugüne kadar vertebra cerrahilerinde intraoperatif kanamada prediktivite açısından trombosit belirteçlerini inceleyen bir araştırma bulunmamaktadır. Bu çalışmada; vertebra cerrahisine girecek hastalarda preoperatif ortalama trombosit hacmi (MPV), trombosit dağılım genişliği (PDW), plateletkrit (PCT), ortalama trombosit hacmi lenfosit sayısı oranı (MPVLR) ve trombosit sayısı lenfosit sayısı oranı (PLR) değerlerinin intraoperatif kanama miktarı tahminindeki etkinliklerini araştırmayı amaçladık. METOD: Etik kurul onayı alındıktan sonra, beyin cerrahisi kliniğince vertebra cerrahisi planlanan hastalar belirlendi. Hastaların cinsiyet, yaş, ASA skoru ve vücut kitle indeksi (VKİ) gibi demografik verileri, preoperatif MPV, PDW, PCT, MPVLR ve PLR değerleri kaydedildi. Cerrahi süresi, cerrahi prosedür olarak vertebra transpediküler vidalama ve laminektomi seviye sayıları kaydedildi. İntraoperatif kanama miktarı ameliyat süresince aspiratörde biriken kan ve spançlardaki kan miktarı üzerinden gerekli hesaplamalar yapılarak elde edildi. BULGULAR: Çalışmaya dahil edilen 63 hastanın %60,3’ü (n=38) kadın, %39,7’si (n=25) erkek idi. Hastaların yaş ortalamaları 54,7 ± 11 yıl, ortalama VKİ 29,6 ± 4,6 idi. Cinsiyet, yaş, MPV, PDW, PCT, MPVLR ve PLR ile kanama miktarı arasında korelasyon saptanmadı. VKİ, cerrahi süresi, transpediküler vidalama segment sayısı ile kanama miktarı arasında ise anlamlı derecede yüksek korelasyon saptandı. SONUÇ: Sonuç olarak; trombosit belirteçlerinin kanama miktarına etkisi görülmemektedir. Bununla birlikte, VKİ arttıkça, cerrahi süre uzadıkça, transpediküler vida segment sayısı arttıkça kanama miktarı artmaktadır.

Keywords

• İntraoperatif Kanama Miktarı
• Ortalama Trombosit Hacmi
• Trombosit Dağılım Genişliği
• Plateletkrit
• Ortalama Trombosit Hacmi Lenfosit Oranı
• Trombosit Lenfosit Oranı

Effectiveness of Platelet Markers ın Estimating the Amount of Intraoperative Bleeding ın Vertebra Surgery

Abstract

Purpose: One of the most important steps in perioperative bleeding management is the predetermination of the patient at risk. Even if there is no hemostatic abnormality in vertebral surgery, which is a major surgery, severe bleeding can be encountered and many perioperative blood transfusions might be required. In this study; we investigated the effectiveness of preoperative mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), mean platelet volume lymphocyte count ratio (MPVLR), and platelet count to lymphocyte count ratio (PLR) values in predicting the amount of intraoperative bleeding in patients who will undergo vertebral surgery. Method: Preoperative MPV, PDW, PCT, MPVLR, PLR values and demographic data such as gender, age, ASA score and body mass index (BMI) were recorded in patients scheduled for vertebral surgery in the neurosurgery clinic. In addition, the duration of surgery, the number of vertebral transpedicular screwing and laminectomy levels as surgical procedure were recorded. The amount of intraoperative bleeding was obtained by calculating the amount of blood accumulated in the aspirator and the amount of blood in the sponges during the operation. Results: Of the 63 patients included in the study, 60.3% (n=38) were female and 39.7% (n=25) were male. The mean age of the patients was 54.7 ± 11 years and the mean BMI was 29.6 ± 4.6. No correlation was found between the amount of bleeding and gender, age, MPV, PDW, PCT, MPVLR, or PLR values. A significantly high correlation was found between amount of bleeding and BMI, duration of surgery, and the number of transpedicular screwing segments. Conclusion: Platelet markers do not appear to have an effect on the amount of bleeding. However; as the BMI increases, the duration of surgery prolongs and the number of transpedicular screw segments increases for which the amount of bleeding increases.

Keywords

• Intraoperative bleeding amount
• Mean platelet volume
• Mean platelet volume lymphocyte ratio
• Platelet distribution width
• Plateletcrit
• Platelet lymphocyte ratio

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