Barannik, A.S.

Barannik, K.S.

Shevtsov, V.M.

Repository for DZ &quot;DMA&quot;

I ..Мм, I', |.иЫ:, ol I ’lihiml M iiv  1(1-1 1. 2(119К К И Л Ш Ы Т А !  ION OK KIDNKV I DNC T ION  IN T H E  P E RI OP E R AT IV  E P E RI ODB aran n ik  K. S.C andidate o f  M edical Sciences,A ssistant o f  the D epartm ent o f  Urology S! ,. / hiipropetrovsk M edical Academ y o f  M in istty  o f  H ealth o f  Ukraine » Dnipro, Ukraine B a ran n ik  A. S.D octor urologist C l «K rivorozhskaya m ultiprojile hospital № 2 »K ryvyi Rih, D nipropetrovsk region, Ukraine Shevtsov V. M.D octor surgeon( 7 «D niprovsky C linical Association o f  E m ergency M edical A id»Dnipro, UkraineU clcvance. A nalysis o f  the literature, conducted prelim inary own research convincingly proved that unilateral lesion o f  the paired organ o f  the kidneys by niiy palhological process affects the state o f  blood circulation in the renal pnrenchyma [1]. This not only leads to a violation o f  the functional state o f  the allcclcd kidney, but also leads to the developm ent o f  pathological m orphological i.Imnges in the kidney tissue. However, the negative im pact extends to the np|H).site kidney. This is a negative reason for the delayed com pensatory-adaptive ipstponse to the restoration o f  the overall function o f  the paired organ [2]. Even, the kidney that rem ained after the removal o f  the affected, can not fully compensate for the total function and is not a «healthy kidney.» The kidneys, due to ihcir functional and anatom ical features, are a good model for studying their hemodynam ics. This allow s the use o f  D oppler renal arteries to determ ine the fxlont o f  organ dam age in system ic diseases [3, 4]. C irculatory disorders in both Kidneys with their unilateral dam age are due to the pathological effect o f  the (liscase on the affected kidney and the developm ent o f  a stable vascular spasm o f  llie opposite kidney parenchym a through the reno-renal reflex (especially during (lie developm ent o f  an acute disease). The flow o f  vasoactive substances into the bloodstream causes a num ber o f  vascular reactions. In this case, the alternation o f  vasoconstriction and vasodilation disrupt the course o f  adequate adaptive reactions to the restoration o f  blood circulation in the kidneys [3, 5]. The midilional effect o f  surgery also negatively affects the adequate recovery o f  total renal function. It is possible to positively influence the blood circulation condition by improving the rheological properties o f  blood and preventing or elim inating vascular spasm o f  the renal parenchym a.2 7Intcmatioiia! scientific coiifercticcI’u rposc  o f the study . Develop and use in the clinic a method o f  perioperative coi rection o f  renal blood flow in patients with unilateral kidney damage.M ate ria l an d  m ethods o f  re sea rch . A clinical study was conducted in 108 patients aged from 18 to 65 years with the study o f  changes in the blood flow o f  the renal parenchym a in various types o f  unilateral pathology, which was carried out for surgical treatm ent. A clinical study was conducted in 108 patients aged from 18 to 65 years w ith the study o f  changes in the blood (low o f  the renal parenchym a in various types o f  unilateral pathology, which was carried out for surgical treatm ent. Patients were divided into 2 com parison groups. Group I consisted o f  58 patients who received conventional treatm ent according to the protocols for providing m edical care for a specific pathology. G roup II consisted o f  50 patients, who additionally carried out perioperative m easures to improve blood flow in the parenchym a o f  both kidneys.All patients on the device Philips H DI IxE  conducted a D oppler exam ination o f  the renal arteries to determ ine the state o f  blood circulation in the renal parenchym a. A t the same tim e, such indicators as the m axim um  systolic velocity o f  the arterial flow  (V m ax), final diastolic velocity (V m in) were evaluated. In the analysis o f  D oppler patterns, such indicators as the resistance index (IP), the pulsation index (PI), and the index o f  systolic-diastolic ratio (SD ) w ere also determ ined. In the quantitative analysis o f  renography, the duration o f  the vascular segm ent was determ ined (20-60 s); the tim e to reach the maxim um  level o f  the Tm ax curve (3-5 min), the half-life o f  the 1311 hippurana from the kidneys is T1 / 2 (8-12 min).R esu lts an d  its d iscussion . The D oppler study o f  the arteries o f  the kidneys on the affected side and in the opposite kidney allowed us to  obtain the following data. Thus, in all cases, the lesion determ ined a persistent decrease in the systolic velocity o f  the arterial flow in the artery o f  the affected kidney, w hich was most pronounced in its distal section, w hich confirm ed the presence o f  the predom inant changes in the arteries o f  the kidney parenchym a. So, Vmax at the level o f  the renal artery w as reduced to 0.80 ±  0.13 m / s (control -  0.87 ±  0.03 m / s), and Vmin at the level o f  the main trunk was 0.25 ±  0.12 m / s (control -  0.32 ±  0.06 m / s). П оказатель СД при этом составлял 3,60±0,23, что почти в 1,5 раза пре­вы ш ало контрольный показатель (2,70±0,23). The changes belonged to IR, w hich also increased and at the level o f  the renal artery was 0,69 ± 0,09 (control -0,63 ± 0,05). PI at the same tim e was 1.37 ±  0.06 (control -  1.27 ±  0.06), which also exceeded its control value. The increase in peripheral vascular resistance in unilateral kidney dam age, especially in case o f  acute obstruction o f  one o f  the kidneys, was associated with an increase in intra-pelvic pressure in the pelvis- pancreas system. This condition can provoke an increase in the level o f  prostaglandins and other vasoactive substances, w hich in turn cause vasoconstriction, m aintain irritation o f  the vascular endothelium , and be an additional stim ulation o f  sustained vasoconstriction.2 8M ; iv  III-1  I.  2 ( ) l ‘)I In cliUTiniiialion o ftlic  hcmociynamic state o f  the contralateral kidney showed ili> ii.lldwiiit; values. Vmax at the renal artery level was increased to 0.90 i- 0.16 III . ((diilm l 0.87 ± 0.03 m / s). and Vmin at the level o f  the main trunk, it was u (K I ( I I I  111 / with (control -  0,32 ± 0,06 m / s). An increase in the speed oC hlnuil (low was a pronounced compensatory nature. Insignificant changes HI I 111 n il with indexes o f  the index o f  resistance and pulse index. Thus, 11̂  slightly im и и-.0(1 and equaled to the renal artery 0.57 ± 0.16 (control -  0.63 ± 0.05). PI in Ihi'. I .ISC was 1,55 і  0,08 (control -  1,27 ± 0,06). The latter indicates a certain im oiisistcncy o f  the total capacity o f  the bloodstream  o f  the opposite kidney to 1 M(ii|H-ns.itory increase in the rate o f  blood flow.Ill view o f  the above, we have developed and im plem ented in practice the (ollinviiig schem e o f  perioperative method o f  correction o f  blood flow o f  both kiiliieys with one-sided defeat that requires surgical intervention. All patients in (hr fvpcriniental group received treatm ent in accordance with the protocols for ( I k * ptovision o f  medical care in accordance with the type o f  disease. Operative lli(iTveiilion was carried out in an adequate am ount aimed at elim inating the pitthological process and its consequences w ith the im plem entation o f  liitmoperative measures to restore the functional state o f  the affected kidney.I nking into account the results o f  the clinical study o f  blood flow, experim ental iliilit on the modeling o f  pathological conditions w ith a stable blood flow and iirodynamics disturbance, the terms o f  the largest circulatory disorder were ilotcmiined: 3rd, 7th, 10th, and 14th days. To elim inate the spasm  o f  the vessels o f  Ihc renal parenchym a prescribed drugs that belong to the group o f  sym patholytic mibstanccs and do not cause adrenolytic effects. They were used for 3 days before иіігцегу and for 2 w eeks o f  surgery. O bligatory was the appointm ent o f  fliiticoagulants before surgery and within 3 days after surgery. In the postoperative pctlod, disaggregation was prescribed for 2 weeks. In the remote postoperative period up to 3-4 m onths, patients w ere offered phytopreparations that have anti- in llmnmatory, antispasm odic, antiseptic effect. In order to control the quality o f  blood circulation restoration in kidney parenchym a after full activation o f  patients ІІІІСГ the operation for 10-14 days, the study o f  blood flow w ith ultrasound or iiidioisotope renography was perform ed. The developed method is used in the (rcatmeiit o f  50 patients w ith unilateral kidney damage.A Пег perioperative correction o f  renal blood flow in patients w ith one-sided rnial impairment for 10-14 days, there was a decrease in the IR index on the renal littery o f  the affected kidney to 0.64 ± 0.24 versus 0.69 ±  0.09, in the segm ental iiitciies the index o f  resistance increased to 0.50 ± 0 .1 6  versus 0.47 ±  0.08, and on intcr-articular arteries it was 0.45 ± 0.24 versus 0.41 ±  0.08. These data indicate tin improvement in blood flow, but this im provem ent was m ore related to the clfccts o f  surgical treatm ent w ith the elim ination o f  the pathological process. The changes in the index o f  the opposite healthy kidney w ere as follows. At the renal iiKery, its value was 0.55 ±  0.14 versus the initial value o f  0.57 ±  0.16, in the ' vmcMlal arteries -  0.29 ± 0.24 versus 0.31 ± 0.06, and in the inter-articular2 9Іпісгіі:ііи)па! нсісіИіГіс сопГсгспссarteries ■ О, 29 + 0.16 versus 0.31 і 0.06. That is, changes w ere systematically noted im provem ent in blood flow by 7-8%.C 'oiicliisions. The u.se o f  medical correction o f  blood llovv in the kidneys o f  patients with one-sided lesions in the perioperative period allows not only to im prove it by 7-8% , but also to create favorable conditions for adequate adaptive- com pensatory reactions to restore the functional state o f  both kidneys.R eferences;1. Баранник С .I., Стусь В.П., Бараниік К.С. Х вилеподібна відповідь су ­динних реакцій нирок на їх однобічне ураж ення. П івденноукраїнський меди- чннії науковий журиші. 2017. №  17{ 17) червень. С. 8-10.2. Стусь В.П., Бараннік К.С. Компенсаторні можливості протилежної нирки при різних видах однобічного порушення кровообігу в експерименті. ІПвден- ноукраїнськіш медичнни науковий ж урнш . 2015. № 10(10) січень. С. 86-88.3. Стусь В .П., Бараннік К.С. Стан кровообігу паренхіми нирок у хворих зі стійким поруш енням уродинаміки. Урологія. 2013. № 3. С. 17-19.4. Стусь В .П., Бараннік К.С. Ф ункціональний стан і компенсаторно- пристосовні можливості парного органа -  нирок в умовах однобічного ура­ження або єдиної нирки, що залиш илася після нефректомії (огляд л ітерату­ри). Урологія. 2016. №1 (76). С. 5-16.5. G om ez-A nson В., C arrero-Lopez V., D iaz-G onzalez R. Im age-directed color D oppler ultrasound evaluation o f  the single kidney after unilateral nephrectom y in adults. J. Clin. Ultrasound. 1997. V .25 ,N  1. P. 29-35.3 0

Rehabilitation of kidney function in the perioperativ period

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Rehabilitation of kidney function in the perioperativ period

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Rehabilitation of kidney function in the perioperativ period

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Repository for DZ &quot;DMA&quot;

Repository for DZ "DMA"