Jatrogēnas anēmijas iestāšanas laiks un citu faktoru ietekme uz to pacientiem IT nodaļā pēc sirds operācijām
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Date
2022
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Jatrogēna anēmija ir aktuāla problēma intensīvās terapijas (IT) nodaļās un attīstās līdz pat 90% pacientu jau ap trešo hospitalizācijas dienu. Dienas vidēja jatrogēna asins zuduma noteikšana, hemoglobīna (Hb) un hematokrīta līmeņu kontrole pacientiem IT nodaļā ļauj noteikt jatrogēnas anēmijas iestāšanās pēcoperācijas dienu un izvērtēt pacientu dzimuma, vecuma, ķermeņa masas un operācijas veida ietekmi uz to. Pētnieciskā darba mērķis bija definēt jatrogēnas anēmijas iestāšanās dienu pacientiem IT nodaļā pēc akūtām un plānveida sirds operācijām un noteikt citu faktoru kā vecuma, dzimuma, ķermeņa masas un operācijas veida ietekmi uz to. Randomizētā retrospektīvā pētījumā tika iekļauti pacienti, kuri laika periodā no 2018. gada līdz 2021. gadam vismaz 48 stundas ārstējās Paula Stradiņa Klīniskās universitātes slimnīcas (PSKUS) 39. Sirds ķirurģijas anestezioloģijas un IT nodaļā pēc sirds operācijām. Klīniskie dati tika iegūti no PSKUS medicīniskās dokumentācijas. Dati tika analizēti IBM SPSS 26.0 programmā, pielietojot statistiskos testus, kā Hī kvadrāta tests, Fišera tiešais tests, neatkarīgo izlašu t-tests, Manna – Vitnija tests un bināra loģistiskā regresija. Par statistiski nozīmīgu tika uzskatīta p vērtība mazāka par 0,05. No 142 pētījumā iekļautajiem pacientiem 51 (35,9%) bija sieviete un 91 (64,1%) – vīrietis vecumā no 40 līdz 87 gadiem. Anēmija attīstījās 135 pacientiem jeb 95,1%, no tiem. 134 (99,3%) agrīnajā pēcoperācijas periodā attīstījās jauktas ģenēzes, bet pamatā ar asiņošanu saistīta anēmija. Vidēji smaga jatrogēna anēmija attīstījās 56 pacientiem (41,48% no visiem pacientiem ar anēmiju). Vidēja iestāšanas diena bija ceturtā pēcoperācijas diena (mediāna – 4. diena, Min = 3, Max = 10). Smaga jatrogēna anēmija attīstījās 37 pacientiem (27,41% no visiem pacientiem ar anēmiju). Vidēja iestāšanas diena bija astotā pēcoperācijas diena (mediāna – 7. diena, Min = 4, Max = 15). Vidējais jatrogēnais asins zudums dienā bija 39,88 ml (mediāna 38,25 ml, Min 21 ml, Max 82 ml). Dienas vidēja jatrogēna asins zuduma atšķirība starp pacientiem pēc akūtām un plānveida operācijām bija statistiski nozīmīga (p=0,027). Vidējais jatrogēnais asins zudums dienā dažādiem operāciju veidiem arī bija atšķirīgs ar statistisku nozīmīgumu (p=0,002). Pacientu dzimumam, vecumam un ķermeņa masai nebija statistiski nozīmīgas ietekmes uz jatrogēnas anēmijas attīstību, tomēr ķermeņa masas saistība ar smagas jatrogēnās anēmijas attīstību ir tuvu statistiski nozīmīgam līmenim (p=0,075). Dažiem sirds operāciju veidiem ir statistiski nozīmīga asociācija ar jatrogēnas anēmijas attīstību (p<0,05). Secinājumi: Jatrogēna anēmija ir bieži sastopama pacientiem PSKUS 39.Sirds ķirurģijas anestezioloģijas un IT nodaļā. Nākotnes pētījumiem vajadzētu izvērtēt eritrocītu un trombocītu masu, svaigi saldētās plazmas, krioprecipitātu transfūzijas un ievadīto kristaloīdu un koloīdu šķīdumu tilpumus un to izraisītās izmaiņas Hb un hematokrīta līmeņos.
Iatrogenic anemia is a common problem in the intensive care unit (ICU). Approximately 90% of patients in the ICU develop iatrogenic anemia at the third day of hospitalization. Measurement of mean daily blood loss, control of daily hemoglobin and hematocrit changes enables us to define the onset of iatrogenic anemia and analyze the impact of other factors as gender, age, body mass and surgery type. The aim of this study was to define the time of the onset of iatrogenic anemia in patients staying in the ICU after acute and elective open-heart surgery and to evaluate the impact of different factors as gender, age, body mass and type of surgery. Randomized retrospective study included patients that received open-heart surgery at Pauls Stradiņš Clinical University Hospital and later stayed at the ICU for at least 48 hours. Clinical data was provided by the patient’s medical history. Collected data was analyzed in IBM SPSS 26.0 using statistical tests as Chi square, Fisher exact test, independent samples t-test, Mann-Whitney test, binary logistics regression. P value smaller than 0,05 was determined to be statistically significant. Of 142 patients reviewed, there were 51 (35,9%) women and 91 (64,1%) men, aged between 40 and 87 years. A total of 135 (95,1%) developed anemia. Early in the post-operative period 134 (99,3%) developed hemorrhage associated anemia. Moderate iatrogenic anemia was found in 56 patients (41,48% of all anemic). Average onset of moderate iatrogenic anemia was on Day 4 (Median – Day 4) with Min Day 3 and Max Day 10 post-surgery. Severe iatrogenic anemia was found in 37 patients (27,41% of all anemic). Average onset of severe iatrogenic anemia was on Day 8 (Median – Day 7) with Min Day 4 and Max Day 15 post-surgery. Average daily iatrogenic blood loss was 39,88 ml (Median 38,25 ml, Min 21 ml, Max 82 ml). Difference between average daily blood loss after acute and elective surgery was statistically significant (p=0,027). Average daily blood loss after different types of open-heart surgeries was different with statistical significance (p=0,002). There was no association between moderate and severe iatrogenic anemia and gender, body mass and age, although body mass and severe iatrogenic anemia development association was almost at the level of significance (p=0,075). There was an association between some types of open-heart surgery and iatrogenic anemia(p<0,05). Conclusions. Iatrogenic anemia is common in Pauls Stradiņš Clinical University Hospital cardiosurgical ICU patients. Future research should analyze red blood cell mass, platelet mass, fresh frozen plasma, cryoprecipitate transfusions and infused crystalloids and colloids volume association with changes in Hb and hematocrit levels.
Iatrogenic anemia is a common problem in the intensive care unit (ICU). Approximately 90% of patients in the ICU develop iatrogenic anemia at the third day of hospitalization. Measurement of mean daily blood loss, control of daily hemoglobin and hematocrit changes enables us to define the onset of iatrogenic anemia and analyze the impact of other factors as gender, age, body mass and surgery type. The aim of this study was to define the time of the onset of iatrogenic anemia in patients staying in the ICU after acute and elective open-heart surgery and to evaluate the impact of different factors as gender, age, body mass and type of surgery. Randomized retrospective study included patients that received open-heart surgery at Pauls Stradiņš Clinical University Hospital and later stayed at the ICU for at least 48 hours. Clinical data was provided by the patient’s medical history. Collected data was analyzed in IBM SPSS 26.0 using statistical tests as Chi square, Fisher exact test, independent samples t-test, Mann-Whitney test, binary logistics regression. P value smaller than 0,05 was determined to be statistically significant. Of 142 patients reviewed, there were 51 (35,9%) women and 91 (64,1%) men, aged between 40 and 87 years. A total of 135 (95,1%) developed anemia. Early in the post-operative period 134 (99,3%) developed hemorrhage associated anemia. Moderate iatrogenic anemia was found in 56 patients (41,48% of all anemic). Average onset of moderate iatrogenic anemia was on Day 4 (Median – Day 4) with Min Day 3 and Max Day 10 post-surgery. Severe iatrogenic anemia was found in 37 patients (27,41% of all anemic). Average onset of severe iatrogenic anemia was on Day 8 (Median – Day 7) with Min Day 4 and Max Day 15 post-surgery. Average daily iatrogenic blood loss was 39,88 ml (Median 38,25 ml, Min 21 ml, Max 82 ml). Difference between average daily blood loss after acute and elective surgery was statistically significant (p=0,027). Average daily blood loss after different types of open-heart surgeries was different with statistical significance (p=0,002). There was no association between moderate and severe iatrogenic anemia and gender, body mass and age, although body mass and severe iatrogenic anemia development association was almost at the level of significance (p=0,075). There was an association between some types of open-heart surgery and iatrogenic anemia(p<0,05). Conclusions. Iatrogenic anemia is common in Pauls Stradiņš Clinical University Hospital cardiosurgical ICU patients. Future research should analyze red blood cell mass, platelet mass, fresh frozen plasma, cryoprecipitate transfusions and infused crystalloids and colloids volume association with changes in Hb and hematocrit levels.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
jatrogēna anēmija; kardioķirurģija; intensīvā terapija, iatrogenic anemia; cardiac surgery; intensive care unit