Učinak produljenoga radnoga vremena na aktivaciju hemostatskoga sustava [The effect of prolonged working time on activation of hemostatic system ]

Matijaca, Hana (2019) Učinak produljenoga radnoga vremena na aktivaciju hemostatskoga sustava [The effect of prolonged working time on activation of hemostatic system ]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

The workplace stress leads to the activation of the hemostatic system and can also generate proinflammatory mediators. The aim of this study was to examine the effect of the 24- hour shift on coagulation tests of PV, INR, APTV, TV, D-dimers, fibrinolysis, fibrinogen, activity of factor VIII and vWF, TAT and PAP complexes and on CRP as an acute inflammatory agent. Sixty physicians (residents) between age of 25 and 35 at Clinical Hospital Centre “Sestre milosrdnice” in the Center for Emergency Reception participated (30 participants in the experimental and 30 participants in control group). Blood samples were collected on three occasions at the same points in both groups: shortly before the 24 hour shift, twelve hours after and at the end of the shift. The results showed statistically significantly higher values of CRP in all three measurements in the experimental group (P=0,024, P=0,020, P=0,030). There was a statistically significant difference in factor VIII (P=0,029) and vWF (P=0.042) activity dynamics between the groups. There was no statistically significant difference in the values of other factors. Thus, only the CRP values were statistically significantly higher in the experimental group. Factor VIII was initially higher in subjects but decreased at the end of 24 hour shift, while surprisingly other indicators of hemostatic system have not demonstrated blood procoagulant state in doctors who worked 24 hour shift or have even shown hypocoagulant state at the end of 24 hour shift (lower VWF activity, trend of lower D-dimers and reduction of factor VIII activity).

Abstract in Croatian

Stres na radnom mjestu aktivira hemostatski sustav što može rezultirati prokoagulantnim stanjem. Također ima utjecaj na stvaranje proupalnih medijatora. Cilj ovog rada bio je ispitati utjecaj 24-satnog dežurstva na pretrage hemostaze: PV, INR, APTV, TV, D-dimere, vrijeme fibrinolize, fibrinogen, aktivnost faktora VIII i vWF, TAT i PAP komplekse, te CRP-a kao akutnog reaktanta upale. Istraživanje je provedeno na 60 liječnika na specijalističkom usavršavanju životne dobi od 25 do 35 godina u KBC “Sestre milosrdnice“ u Centru za hitni prijem (30 liječnika kojima je rad povremeno organiziran u obliku 24-satnog dežurstva i 30 liječnika u kontrolnoj skupini). U obje skupine je krv uzeta tri puta u istim vremenskim točkama (neposredno prije, nakon dvanaest sati, te na kraju 24-satnog dežurstva). Rezultati su pokazali statistički značajno više vrijednosti CRP-a kroz sva tri mjerenja u skupini dežurnih liječnika (P=0,024, P=0,020, P=0,030). Također je dokazana statistički značajna razlika u dinamici aktivnosti faktora VIII (P=0,029) i vWF (P=0,042) između skupina.. Nisu dokazane statistički značajne razlike u ostalim mjerenim parametrima. Zaključno, vrijednosti CRP su bile statistički značajno više u dežurnoj skupini. Faktor VIII je bio inicijalno viši u ispitanika, ali se snižavao na kraju dežurstva, dok iznenađujuće ostali pokazatelji hemostaze nisu pokazali prokoagulantnost krvi u liječnika koji dežuraju ili su čak pokazali hipokoagulabilnost na kraju dežurstva (niža aktivnost vWF, trend nižim D-dimerima i sniženju aktivnosti faktora VIII).

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