transmedТрансляционная медицинаTranslational Medicine2311-44952410-5155Almazov National Medical Research Centre, Saint Petersburg, Russia10.18705/2311-4495-2016-3-5-34-41transmed-224Research ArticleАНЕСТЕЗИОЛОГИЯ И РЕАНИМАТОЛОГИЯPAIN, CRITICAL CARE, AND ANESTHESIAСКРИНИНГ ГИПЕРКОАГУЛЯЦИОННЫХ НАРУШЕНИЙ ПРИ СЕПСИСЕSCREENING FOR HYPERCOAGULABILITY IN SEPSISОсовскихВ. В.OsovskikhV. V.

к.м.н., руководитель научной группы анестезиологии и реаниматологии

ул. Ленинградская, д. 70, пос. Песочный, Санкт-Петербург, Россия, 197758

PhD, head of the group of Anesthesiology and intensive care

Leningradskaya str., 70 Pesochniy pos., Saint Petersburg, Russia, 197758

osoff@mail.ruВасильеваМ. С.VasilievaM. S.

клинический ординатор

clinical intern

КрайсветнаяЕ. В.KraisvetnaiaE. V.

врач отделения анестезиологии и реаниматологии клиники

physician at Anesthesiology and intensive care unit

БаутинА. Е.BautinA. E.

к.м.н., заведующий лабораторией анестезиологии и реаниматологии

PhD, head of the laboratory of Anesthesiology and intensive care

Федеральное государственное бюджетное учреждение «Российский научный центр радиологии и хирургических технологий» Министерства здравоохранения Российской ФедерацииРоссияFederal state budgetary institution «Russian scientific center of radiology and surgical technologies» of the ministry of healthcare of the Russian FederationRussian FederationФедеральное государственное бюджетное учреждение «Северо-Западный Федеральный медицинский исследовательский центр им. В. А . Алмазова» Минздрава РоссииРоссияFederal Almazov North-West Medical Research CentreRussian Federation201630012017353441Copyright © Осовских В.В., Васильева М.С., Крайсветная Е.В., Баутин А.Е., 20172017Осовских В.В., Васильева М.С., Крайсветная Е.В., Баутин А.Е.Osovskikh V.V., Vasilieva M.S., Kraisvetnaia E.V., Bautin A.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://transmed.almazovcentre.ru/jour/article/view/224Введение

Введение. Синдром диссеминированного внутрисосудистого свертывания крови (ДВС) является независимым фактором риска при сепсисе. Проблема выявления ранней гиперкоагуляционной стадии ДВС к настоящему времени не решена из-за отсутствия доступных тестов. Результаты тромбоэластометрии (ТЭМ) и теста генерации тромбина (ТГТ ) в условиях сепсиса противоречивы.

Цель исследования

Цель исследования: сравнить возможности Т ЭМ, ТГТ в модификации с рекомбинантным человеческим тромбомодулином (ТМ) и локальных тестов для выявления гиперкоагуляции при сепсисе.

Материалы и методы

Материалы и методы. При ТЭМ-мониторинге пациентов с сепсисом гиперкоагуляция выявлена в 21 случае. Кроме модифицированного ТГТ , определяли скрининговые показатели коагуляции и уровни физиологических антикоагулянтов.

Результаты

Результаты. Отсутствие генерации тромбина выявлено в 2 случаях из 21. Г иперкоагуляция в виде повышения ETP и Peak выявлена только в одном наблюдении. В модификации ТГТ с Т М в 15 случаях из 19 выявлена низкая чувствительность к Т М: снижение ЕТР на 14 % [8,8–24], а Peak на 8% [3,4–12,5]. Таким образом, тромбоэластометрически выявленная гиперкоагуляция подтверждена различными вариантами ТГТ только в 16 случаях из 19 (84,2%). Динамические критерии ТЭМ (например, CFT intem) высоко коррелировали со степенью снижения ETP и Peak.

Заключение

Заключение. Гиперкоагуляция при сепсисе часто обусловлена недостаточностью в системе протеина С. Т ЭМ представляется чувствительным методом скрининга гиперкоагуляции при сепсисе.

Background

Background. Overt disseminated intravascular coagulation (DIC) is independent risk factor in sepsis. Hypercoagulability, present in pre-DIC state, is hardly detected by available screening tests. T hromboelastometry (TEM) and thrombin generation test (TG) showed contradictory results in sepsis.

Objectives

Objectives. The aim of the study is to compare the screening potential of T EM, TG and local tests to detect hypercoagulability in sepsis.

Design and methods

Design and methods. TEM screening of septic patients revealed hypercoagulability in 21 cases. T G test were performed along with screening coagulation tests and physiological anticoagulants.

Results

Results. There was no thrombin generation in 2 of 21 cases. Increased ETP and Peak revealed only in one case. T he degree of T M-modulated suppression of T G was abnormally low in 15 cases out of 19. Median ETP suppression was only 14% [8,8–24], Peak suppression was 8% [3,4–12,5]. T hus, T EM- identified hypercoagulability was confirmed by both T G and TM+TG tests only in 16 cases (84.2%). Dynamic T EM-criteria (CFT intem) highly correlated with ETP- and PTsuppression values.

Conclusion

Conclusion. Hypercoagulability during sepsis is often due to abnormality in PC pathway. TEM appears to be sensitive POC tool to detect hypercoagulability in sepsis.

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The authors declare that there are no conflicts of interest present.