Журнал «Медицина неотложных состояний» Том 19, №4, 2023

Тромбоцитопенія — це гетерогенна група розладів, визначальною ознакою яких є кількість тромбоцитів нижче від нижньої межі норми в 150 × 109/л, а виявлення цього розладу під час госпіталізації є достатньо поширеним феноменом. Тромбоцитопенія часто спостерігається у хворих різного профілю: у кардіологічних, акушерсько-гінекологічних, онкологічних, неврологічних і загальнотерапевтичних відділеннях, може перебігати і як самостійне захворювання, і як окремий симптом різних захворювань, що впливають на систему згортання крові. Етіологія тромбоцитопенії при критичному захворюванні часто є складною і багатофакторною. Тромбоцитопенія та можлива кровотеча становлять значні ризики для лікаря-анестезіолога в періопераційному періоді, що впливає на необхідність особливої уваги до пацієнта під час передопераційної підготовки, вибору оптимального методу знеболювання з урахуванням усіх факторів і якісної післяопераційної інтенсивної терапії. У нашій статті ми розглянули сучасні стратегії ведення пацієнтів з періопераційною тромбоцитопенією, запропоновані для досягнення безпечного позитивного результату лікування, і на прикладі двох клінічних випадків показали можливість успішного використання таких стратегій, як призначення стероїдів, антифібринолітичних засобів, уведення внутрішньовенного глобуліну, застосування агоністів рецепторів тромбопоетину і оптимізація гематокриту в умовах сумісної роботи мультидисциплінарної команди — анестезіологів, хірургів і гематологів. Для поліпшення результатів лікування хворих з тромбоцитопеніями і максимального зниження ризиків пацієнтів у періопераційному періоді ми рекомендуємо мультидисциплінарний підхід у підготовці й веденні таких хворих та індивідуальне застосування різних періопераційних стратегій для збільшення кількості тромбоцитів і зменшення інтраопераційної кровотечі у хворих з тромбоцитопеніями різної етіології.

Thrombocytopenia is a heterogeneous group of disorders characterized by a platelet count below the lower limit of normal (150 × 109/L), and detection of this disorder during hospitalization is a fairly common phenomenon. Thrombocytopenia is often observed in patients of various profiles: in cardiology, obstetrics and gyneco­logy, cancer, neurology and general therapeutic departments and can occur as an independent condition or as a separate symptom of various diseases affecting the blood coagulation system. The etiology of thrombocytopenia in critical illness is often complex and multifactorial. Thrombocytopenia and possible bleeding represent significant risks for the anesthesiologist in the perioperative period, which affects the need for special attention to a patient during preoperative preparation, choosing the optimal method of anasthesia taking into account all factors, and high-quality postoperative intensive care. In our article, we reviewed the current proposed approaches to perioperative thrombocytopenia to achieve a safe positive treatment outcome and, using the example of two clinical cases, showed the possibility of successful use of strategies such as administration of steroids, antifibrinolytic agents, intravenous globulin, thrombo-poietin receptor agonists, and hematocrit optimization in conditions of the joint work of a multidisciplinary team — anesthesiologists, surgeons and hematologists. To improve the results of treatment for thrombocytopenia and to minimize the risks in the perioperative period, we recommend a multidisciplinary approach to the preparation and management of such patients and the individual use of various perioperative strategies to increase the number of platelets and reduce intraoperative bleeding in case of thrombocytopenia of various etiologies.

тромбоцитопенія; періопераційний період; інтенсивна терапія

thrombocytopenia; perioperative period; intensive care

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