НАУЧНО-ПРАКТИЧЕСКАЯ КОНФЕРЕНЦИЯ «БОЛЬ. ПРОБЛЕМЫ И РЕШЕНИЯ» 20 ОКТЯБРЯ 2015 Г.

The Scientific-Practical Conference The pain. Problems and Solutions 20 October, 2015.Научно-практическая конференция «Боль. Проблемы и решения» 20 октября 2015 г

ПРОФИЛАКТИКА И ЛЕЧЕНИЕ БОЛЕВЫХ СИНДРОМОВ — ВАЖНОЕ НАПРАВЛЕНИЕ СОВРЕМЕННОЙ МЕДИЦИНЫ

Prevention and treatment of pain syndromes is an important trend in modern medicine.Представляем Вашему вниманию интервью с заведующим научным отделением анестезиологии НИИ СП им. Н.В. Склифосовского доктором медицинских наук профессором Владимиром Хамидовичем Тимербаевым, приуроченное к приближающейся конференции «Боль. Проблемы и решения». Собеседник расскажет о том, каковы современные подходы к лечению болевых синдромов, а также способах их профилактики

Кислородтранспортная система и ее компенсаторные возможности у пострадавших во время операций по поводу травмы живота, осложненной кровопотерей

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.Введение. Острая кровопотеря остается основной причиной смертельных исходов на операционном столе в экстренной хирургии. Однако до сих пор не оценена связь показателей центральной гемодинамики, кислородного баланса и гомеостаза у таких пациентов во время экстренного хирургического лечения с исходами оперативного лечения.Материал и методы. Были обследованы 100 пациентов с острой массивной кровопотерей, оперированных в экстренном порядке. В ходе обследования регистрировали частоту сердечных сокращений, артериальное давление прямым методом, центральное венозное давление. Определяли сердечный индекс, индекс общего периферического сосудистого сопротивления. Исследовали газовый и кислотно-основной составы артериальной и венозной крови. Индекс потребления кислорода (ИПО2), индекс транспорта кислорода, коэффициент экстракции кислорода (КЭО2) определяли по общепринятым формулам. Сформированы две группы по 50 пациентов в каждой, разделенных в зависимости от показателей кислородного баланса (1-я группа - субкомпенсация, 2-я группа - декомпенсация).Результаты. В момент поступления в операционную и после окончания оперативного вмешательства показатели системной гемодинамики больных 1-й и 2-й групп статистически значимо не различались. У пациентов 2-й группы в момент поступления в операционную были статистически значимо более высокие ИПО2 (195 (158; 256) млДмин-м2) и 112,5 (86; 145,3) млДмин-м2), КЭО2 (50 (45,1; 60)% и 25,1 (19,6; 33,2)%) и низкое содержание кислорода в крови (54,4 (48,5; 67,5)% и 75,1 (67,8; 83)%) (р<0,001 для всех показателей). У больных 2-й группы по сравнению с 1-й сохранялись повышенные значения КЭО2 и ИПО2 (р=0,001, статистически значимо) на этапе окончания операции, хотя уровень в крови глюкозы и лактата между группами статистически значимо не различался. Течение послеоперационного периода было осложнено у 9 больных (18%) 1-й группы. В послеоперационном периоде умерли 2 пациента (4%) 1-й группы. Течение послеоперационного периода пациентов 2-й группы осложнилось у 9 больных (18%). В послеоперационном периоде умерли 7 пациентов (14%) 2-й группы.Заключение. У больных, поступавших с выраженными нарушениями кислородного баланса, несмотря на остановку кровотечения, восполнение кровопотери, проведенную интраоперационную интенсивную терапию сохранялись признаки циркуляторной недостаточности, что свидетельствовало об истощении компенсаторных механизмов кислородтранспортной системы. Это подтверждается и более высокой летальностью среди пострадавших данной группы

PREVENTION AND TREATMENT OF PAIN SYNDROMES IS AN IMPORTANT TREND IN MODERN MEDICINE

Prevention and treatment of pain syndromes is an important trend in modern medicine

THE SCIENTIFIC-PRACTICAL CONFERENCE THE PAIN. PROBLEMS AND SOLUTIONS 20 OCTOBER, 2015

The Scientific-Practical Conference The pain. Problems and Solutions 20 October, 2015

Intraoperative Oxygen Status in Patients with Injuries of Abdominal Cavity Organs

Aim: to analyze the oxygen balance in patients with injuries of abdominal cavity organs and acute blood loss during surgery and arrest of bleeding.Material and methods: the study group consisted of 50 patients (49 men and 1 woman, average age: 33 (25.75; 44.5) years) who experienced injuries of abdominal cavity organs complicated by acute massive blood loss requiring urgent surgical interventions. The severity of patients' state was 38 (27.75; 48) by ISS scoring. The study examined the following parameters: the blood loss volume, hemoglobin (Hg) level, hematocrit (HCT), blood gases, oxygen balance, acid-base balance, electrolyte levels, and the tissue metabolism status. A continuous minimally invasive monitoring of central hemodynamics parameters was performed. The statistical data processing was per- formed using the SPSS software (SPSS Inc., USA).Results: the central hemodynamics parameters did not reflect the severity of patients' state at their admission into an operating room. The signs of hypovolemia were observed along with normal vascular tone and cardiac out- put. At the same time, such parameters of oxygen balance as high VO2I and О2ER, as well as low SvО2 indicated the severity of patients' state. These data demonstrated that patients experienced a severe episode of respiratory or circulatory hypoxia during trauma, which had been corrected during first aid treatment and transportation by patient's admission into the operating room, so patients presented lab test findings of «oxygen debt». The VO2I values remained high in addition to the increase in О2ER values by the end of the surgery. However, low CvO2, PvO2, and SvО2 values indicated the persisting circulatory hypoxia.Conclusion: All patients with postoperative complications were admitted into the operating room with already existing impairment of oxygen delivery. The patients did not recover from shock, the low cardiac efficiency was the main reason for its persistence. The correlation between postoperative lethal outcomes and the value of cardiac index (CI) at the end of surgery in this group of patients was demonstrated

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