2 research outputs found
ΠΠΈΡΠ»ΠΎΡΠΎΠ΄ΡΡΠ°Π½ΡΠΏΠΎΡΡΠ½Π°Ρ ΡΠΈΡΡΠ΅ΠΌΠ° ΠΈ Π΅Π΅ ΠΊΠΎΠΌΠΏΠ΅Π½ΡΠ°ΡΠΎΡΠ½ΡΠ΅ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ Ρ ΠΏΠΎΡΡΡΠ°Π΄Π°Π²ΡΠΈΡ Π²ΠΎ Π²ΡΠ΅ΠΌΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΡΡΠ°Π²ΠΌΡ ΠΆΠΈΠ²ΠΎΡΠ°, ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½Π½ΠΎΠΉ ΠΊΡΠΎΠ²ΠΎΠΏΠΎΡΠ΅ΡΠ΅ΠΉ
Background. Acute hemorrhage remains the leading cause of death on the operating room in emergency surgery. However, the correlation of the central hemodynamics, oxygen balance and homeostasis in such victims during emergency surgical treatment with the outcomes of surgical treatment has not yet been evaluated.Material and methods. We examined 100 patients with acute massive blood loss, who had emergency surgery. We determined heart rate, arterial pressure by direct and indirect methods, central venous pressure, oxygen saturation of blood, cardiac index, systemic vascular resistance, gas and acid-base contents of arterial and venous blood, oxygen consumption, oxygen delivery, oxygen extraction ratio according to generally accepted formulas. Two groups of patients were formed of 50 people, depending on the oxygen balance (Group 1 - subcompensation, Group 2 - decompensation).Results. At the time of admission to the operating room and after the surgery, the indicators of systemic hemodynamics in patients of both groups did not differ statistically significantly. In the Group 2, at the time of admission to the operating room, there were statistically significantly higher VO2 (195 (158, 256) ml/(min-m2) and 112.5 (86; 145.3) ml/(min-m2)), ERO2 (50 (45.1, 60) % and 25.1 (19.6, 33.2) %) and low SvO2 (54.4 (48.5, 67.5) % and 75.1 (67,8; 83) %) (p<0.001 for all indicators). In the Group 2, there were increased values of ERO2 and VO2 (p=0.001) at the end of the operation compared to the Group 1, although the glucose and lactate levels did not differ statistically significantly between the groups. The course of the postoperative period was complicated in 9 (18%) patients of the Group 1 and 2 (4%) patients died. The course of the postoperative period of patients in the Group 2 was complicated in 9 (18%) patients and 7 (14%) patients died.Conclusion . Circulatory insufficiency persisted in patients who had severe oxygen deficiency disorders, despite management of bleeding, replenishment of blood loss, intraoperative intensive therapy, indicating the depletion of the compensatory mechanisms of the oxygen transport system. This was confirmed by a higher mortality rate among the victims of this group.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. ΠΡΡΡΠ°Ρ ΠΊΡΠΎΠ²ΠΎΠΏΠΎΡΠ΅ΡΡ ΠΎΡΡΠ°Π΅ΡΡΡ ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠΉ ΠΏΡΠΈΡΠΈΠ½ΠΎΠΉ ΡΠΌΠ΅ΡΡΠ΅Π»ΡΠ½ΡΡ
ΠΈΡΡ
ΠΎΠ΄ΠΎΠ² Π½Π° ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΡΡΠΎΠ»Π΅ Π² ΡΠΊΡΡΡΠ΅Π½Π½ΠΎΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΠΈ. ΠΠ΄Π½Π°ΠΊΠΎ Π΄ΠΎ ΡΠΈΡ
ΠΏΠΎΡ Π½Π΅ ΠΎΡΠ΅Π½Π΅Π½Π° ΡΠ²ΡΠ·Ρ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΡΠ΅Π½ΡΡΠ°Π»ΡΠ½ΠΎΠΉ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ, ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Π½ΠΎΠ³ΠΎ Π±Π°Π»Π°Π½ΡΠ° ΠΈ Π³ΠΎΠΌΠ΅ΠΎΡΡΠ°Π·Π° Ρ ΡΠ°ΠΊΠΈΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π²ΠΎ Π²ΡΠ΅ΠΌΡ ΡΠΊΡΡΡΠ΅Π½Π½ΠΎΠ³ΠΎ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Ρ ΠΈΡΡ
ΠΎΠ΄Π°ΠΌΠΈ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠ»ΠΈ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½Ρ 100 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΡΡΡΠΎΠΉ ΠΌΠ°ΡΡΠΈΠ²Π½ΠΎΠΉ ΠΊΡΠΎΠ²ΠΎΠΏΠΎΡΠ΅ΡΠ΅ΠΉ, ΠΎΠΏΠ΅ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
Π² ΡΠΊΡΡΡΠ΅Π½Π½ΠΎΠΌ ΠΏΠΎΡΡΠ΄ΠΊΠ΅. Π Ρ
ΠΎΠ΄Π΅ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π»ΠΈ ΡΠ°ΡΡΠΎΡΡ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΡΡ
ΡΠΎΠΊΡΠ°ΡΠ΅Π½ΠΈΠΉ, Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠ΅ Π΄Π°Π²Π»Π΅Π½ΠΈΠ΅ ΠΏΡΡΠΌΡΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ, ΡΠ΅Π½ΡΡΠ°Π»ΡΠ½ΠΎΠ΅ Π²Π΅Π½ΠΎΠ·Π½ΠΎΠ΅ Π΄Π°Π²Π»Π΅Π½ΠΈΠ΅. ΠΠΏΡΠ΅Π΄Π΅Π»ΡΠ»ΠΈ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΡΠΉ ΠΈΠ½Π΄Π΅ΠΊΡ, ΠΈΠ½Π΄Π΅ΠΊΡ ΠΎΠ±ΡΠ΅Π³ΠΎ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠ³ΠΎ ΡΠΎΠΏΡΠΎΡΠΈΠ²Π»Π΅Π½ΠΈΡ. ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π»ΠΈ Π³Π°Π·ΠΎΠ²ΡΠΉ ΠΈ ΠΊΠΈΡΠ»ΠΎΡΠ½ΠΎ-ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠΉ ΡΠΎΡΡΠ°Π²Ρ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΈ Π²Π΅Π½ΠΎΠ·Π½ΠΎΠΉ ΠΊΡΠΎΠ²ΠΈ. ΠΠ½Π΄Π΅ΠΊΡ ΠΏΠΎΡΡΠ΅Π±Π»Π΅Π½ΠΈΡ ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Π° (ΠΠΠ2), ΠΈΠ½Π΄Π΅ΠΊΡ ΡΡΠ°Π½ΡΠΏΠΎΡΡΠ° ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Π°, ΠΊΠΎΡΡΡΠΈΡΠΈΠ΅Π½Ρ ΡΠΊΡΡΡΠ°ΠΊΡΠΈΠΈ ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Π° (ΠΠΠ2) ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ»ΠΈ ΠΏΠΎ ΠΎΠ±ΡΠ΅ΠΏΡΠΈΠ½ΡΡΡΠΌ ΡΠΎΡΠΌΡΠ»Π°ΠΌ. Π‘ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½Ρ Π΄Π²Π΅ Π³ΡΡΠΏΠΏΡ ΠΏΠΎ 50 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π² ΠΊΠ°ΠΆΠ΄ΠΎΠΉ, ΡΠ°Π·Π΄Π΅Π»Π΅Π½Π½ΡΡ
Π² Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Π½ΠΎΠ³ΠΎ Π±Π°Π»Π°Π½ΡΠ° (1-Ρ Π³ΡΡΠΏΠΏΠ° - ΡΡΠ±ΠΊΠΎΠΌΠΏΠ΅Π½ΡΠ°ΡΠΈΡ, 2-Ρ Π³ΡΡΠΏΠΏΠ° - Π΄Π΅ΠΊΠΎΠΌΠΏΠ΅Π½ΡΠ°ΡΠΈΡ).Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π ΠΌΠΎΠΌΠ΅Π½Ρ ΠΏΠΎΡΡΡΠΏΠ»Π΅Π½ΠΈΡ Π² ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ ΠΈ ΠΏΠΎΡΠ»Π΅ ΠΎΠΊΠΎΠ½ΡΠ°Π½ΠΈΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠΉ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ
1-ΠΉ ΠΈ 2-ΠΉ Π³ΡΡΠΏΠΏ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ Π½Π΅ ΡΠ°Π·Π»ΠΈΡΠ°Π»ΠΈΡΡ. Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² 2-ΠΉ Π³ΡΡΠΏΠΏΡ Π² ΠΌΠΎΠΌΠ΅Π½Ρ ΠΏΠΎΡΡΡΠΏΠ»Π΅Π½ΠΈΡ Π² ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ Π±ΡΠ»ΠΈ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ Π±ΠΎΠ»Π΅Π΅ Π²ΡΡΠΎΠΊΠΈΠ΅ ΠΠΠ2 (195 (158; 256) ΠΌΠ»ΠΠΌΠΈΠ½-ΠΌ2) ΠΈ 112,5 (86; 145,3) ΠΌΠ»ΠΠΌΠΈΠ½-ΠΌ2), ΠΠΠ2 (50 (45,1; 60)% ΠΈ 25,1 (19,6; 33,2)%) ΠΈ Π½ΠΈΠ·ΠΊΠΎΠ΅ ΡΠΎΠ΄Π΅ΡΠΆΠ°Π½ΠΈΠ΅ ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Π° Π² ΠΊΡΠΎΠ²ΠΈ (54,4 (48,5; 67,5)% ΠΈ 75,1 (67,8; 83)%) (Ρ<0,001 Π΄Π»Ρ Π²ΡΠ΅Ρ
ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ). Π£ Π±ΠΎΠ»ΡΠ½ΡΡ
2-ΠΉ Π³ΡΡΠΏΠΏΡ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ 1-ΠΉ ΡΠΎΡ
ΡΠ°Π½ΡΠ»ΠΈΡΡ ΠΏΠΎΠ²ΡΡΠ΅Π½Π½ΡΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΠΠΠ2 ΠΈ ΠΠΠ2 (Ρ=0,001, ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ) Π½Π° ΡΡΠ°ΠΏΠ΅ ΠΎΠΊΠΎΠ½ΡΠ°Π½ΠΈΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ, Ρ
ΠΎΡΡ ΡΡΠΎΠ²Π΅Π½Ρ Π² ΠΊΡΠΎΠ²ΠΈ Π³Π»ΡΠΊΠΎΠ·Ρ ΠΈ Π»Π°ΠΊΡΠ°ΡΠ° ΠΌΠ΅ΠΆΠ΄Ρ Π³ΡΡΠΏΠΏΠ°ΠΌΠΈ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ Π½Π΅ ΡΠ°Π·Π»ΠΈΡΠ°Π»ΡΡ. Π’Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΏΠ΅ΡΠΈΠΎΠ΄Π° Π±ΡΠ»ΠΎ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΎ Ρ 9 Π±ΠΎΠ»ΡΠ½ΡΡ
(18%) 1-ΠΉ Π³ΡΡΠΏΠΏΡ. Π ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ ΡΠΌΠ΅ΡΠ»ΠΈ 2 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° (4%) 1-ΠΉ Π³ΡΡΠΏΠΏΡ. Π’Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΏΠ΅ΡΠΈΠΎΠ΄Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² 2-ΠΉ Π³ΡΡΠΏΠΏΡ ΠΎΡΠ»ΠΎΠΆΠ½ΠΈΠ»ΠΎΡΡ Ρ 9 Π±ΠΎΠ»ΡΠ½ΡΡ
(18%). Π ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ ΡΠΌΠ΅ΡΠ»ΠΈ 7 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (14%) 2-ΠΉ Π³ΡΡΠΏΠΏΡ.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π£ Π±ΠΎΠ»ΡΠ½ΡΡ
, ΠΏΠΎΡΡΡΠΏΠ°Π²ΡΠΈΡ
Ρ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΡΠΌΠΈ Π½Π°ΡΡΡΠ΅Π½ΠΈΡΠΌΠΈ ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Π½ΠΎΠ³ΠΎ Π±Π°Π»Π°Π½ΡΠ°, Π½Π΅ΡΠΌΠΎΡΡΡ Π½Π° ΠΎΡΡΠ°Π½ΠΎΠ²ΠΊΡ ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΡ, Π²ΠΎΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠ΅ ΠΊΡΠΎΠ²ΠΎΠΏΠΎΡΠ΅ΡΠΈ, ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π½ΡΡ ΠΈΠ½ΡΡΠ°ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΡΡ ΡΠ΅ΡΠ°ΠΏΠΈΡ ΡΠΎΡ
ΡΠ°Π½ΡΠ»ΠΈΡΡ ΠΏΡΠΈΠ·Π½Π°ΠΊΠΈ ΡΠΈΡΠΊΡΠ»ΡΡΠΎΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ, ΡΡΠΎ ΡΠ²ΠΈΠ΄Π΅ΡΠ΅Π»ΡΡΡΠ²ΠΎΠ²Π°Π»ΠΎ ΠΎΠ± ΠΈΡΡΠΎΡΠ΅Π½ΠΈΠΈ ΠΊΠΎΠΌΠΏΠ΅Π½ΡΠ°ΡΠΎΡΠ½ΡΡ
ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΠΎΠ² ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄ΡΡΠ°Π½ΡΠΏΠΎΡΡΠ½ΠΎΠΉ ΡΠΈΡΡΠ΅ΠΌΡ. ΠΡΠΎ ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠΆΠ΄Π°Π΅ΡΡΡ ΠΈ Π±ΠΎΠ»Π΅Π΅ Π²ΡΡΠΎΠΊΠΎΠΉ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΡΡ ΡΡΠ΅Π΄ΠΈ ΠΏΠΎΡΡΡΠ°Π΄Π°Π²ΡΠΈΡ
Π΄Π°Π½Π½ΠΎΠΉ Π³ΡΡΠΏΠΏΡ
Oxygen Transport System and Its Compensatory Capabilities for Victims During Operations for Abdominal Trauma, Complicated by Blood Loss
Background. Acute hemorrhage remains the leading cause of death on the operating room in emergency surgery. However, the correlation of the central hemodynamics, oxygen balance and homeostasis in such victims during emergency surgical treatment with the outcomes of surgical treatment has not yet been evaluated.Material and methods. We examined 100 patients with acute massive blood loss, who had emergency surgery. We determined heart rate, arterial pressure by direct and indirect methods, central venous pressure, oxygen saturation of blood, cardiac index, systemic vascular resistance, gas and acid-base contents of arterial and venous blood, oxygen consumption, oxygen delivery, oxygen extraction ratio according to generally accepted formulas. Two groups of patients were formed of 50 people, depending on the oxygen balance (Group 1 - subcompensation, Group 2 - decompensation).Results. At the time of admission to the operating room and after the surgery, the indicators of systemic hemodynamics in patients of both groups did not differ statistically significantly. In the Group 2, at the time of admission to the operating room, there were statistically significantly higher VO2 (195 (158, 256) ml/(min-m2) and 112.5 (86; 145.3) ml/(min-m2)), ERO2 (50 (45.1, 60) % and 25.1 (19.6, 33.2) %) and low SvO2 (54.4 (48.5, 67.5) % and 75.1 (67,8; 83) %) (p<0.001 for all indicators). In the Group 2, there were increased values of ERO2 and VO2 (p=0.001) at the end of the operation compared to the Group 1, although the glucose and lactate levels did not differ statistically significantly between the groups. The course of the postoperative period was complicated in 9 (18%) patients of the Group 1 and 2 (4%) patients died. The course of the postoperative period of patients in the Group 2 was complicated in 9 (18%) patients and 7 (14%) patients died.Conclusion . Circulatory insufficiency persisted in patients who had severe oxygen deficiency disorders, despite management of bleeding, replenishment of blood loss, intraoperative intensive therapy, indicating the depletion of the compensatory mechanisms of the oxygen transport system. This was confirmed by a higher mortality rate among the victims of this group