[Extracorporeal treatment of hemolytic complications in multifield surgical clinic]. / Problema ekstrakorporal'noi terapii gemoliticheskikh oslozhnenii v mnogoprofil'noi khirurgicheskoi klinike.

AIM: to optimize the protocol of high-volume plasmapheresis for hemolytic complications in surgical practice. MATERIAL AND METHODS: We studied 100 patients aged 7-73 years with hemolytic complications. In 83 patients with free hemoglobin level over 200 mg% 50-300% of plasma volume was removed. In 32 patients (15 of them with plasmapheresis and 17 without it) renal function was assessed comparatively. Plasmapheresis was used in case of significantly higher values of hemolysis (p<0.01). RESULTS: Cardiac patients make 95% of observations. They had intraoperative hemolysis due to plonged extracorporeal circulation (93) and injection of 16-18-day blood preserved with glugjcirum into pump oxygenator (2). Hemolytic complications were observed in 5 patients. Autoerythrocytes disintegration occurred in 95 cases. Efficacy of plasmapheresis to eliminate free hemoglobin was 95%. Severity of acute renal injury depended on hymolysis intensity. Renal function recovery was diagnosed in 2-3 days postoperatively. Plasmapheresis facilitated microalbuminuria and concentration function restoration.

The use of high doses of aprotinin to decrease blood loss in aortocoronary by-pass surgery.

There were examined 100 patients who had been operated in extracorporeal circulation for ischemic heart disease. In the 1st group (50 patients), each patient intraoperatively received 6,000,000 KIE of aprotinin; in the 2nd group (50 patients) placebo. Both groups were similar as for the age, duration of extracorporeal circulation, and myocardium anoxia. The total intraoperative blood loss was higher in 2nd group, 638 +/- 5 ml and 952.4 +/- 15.5 ml p < 0.05 correspondingly. The rate of cases without the intraoperative use of donor blood was 42% in group 1 and 18% in group 2. The postoperative blood loss was significantly lower with the use of aprotinin, 392 +/- 6.6 ml and 689.7 +/- 9.6 ml, p < 0.05 correspondingly; and in that the Hb concentration in the drainage blood was higher in group 2: 31.3 +/- 0.5 g and 73.1 +/- 2.2 g, p < 0.05. In group 1 22% of the patients received donor blood in the early postoperative period, and group 2 twice as many -56%. Thus prolonged intraoperative use of large aprotinin dosages in aortocoronary by-pass surgery is an effective means for stabilization of homeostasis, and it allows to reduce intra- and postoperative blood loss and diminishes the requirements in donor blood.