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"Emergency medicine" №3(98), 2019

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Оptimal strategy of perioperative infusion: pros and cons

Authors: Кравец О.В., Клигуненко Е.Н.
ГУ «Днепропетровская медицинская академия МЗ Украины», г. Днепр, Украина

Categories: Medicine of emergency

Sections: Specialist manual

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Summary

Лікування абдомінальної патології у 80 % випадків виконується хірургічно. За даними Національного конфіденційного комітету розрахунку результатів лікування та смертності (NCEPOD, 2016), післяопераційна летальність при планових оперативних втручаннях становить 4 %, в умовах ургентної хірургії коливається між 19,7 та 23,1 %. Періопераційна інфузійна терапія є динамічним процесом доопераційного усунення гіповолемії, інтраопераційної підтримки об’єму циркулюючої крові та його післяопераційної стабілізації. Пошук літературних джерел здійснено за ключовими словами у базах даних Scopus, Web of Science, MedLine, The Cochrane Library.

Лечение абдоминальной патологии в 80 % случаев проводится хирургическим путем. По данным Национального конфиденциального комитета подсчета результатов лечения и смертности (NCEPOD, 2016), послеоперационная летальность при плановых оперативных вмешательствах составляет 4 %, в ургентной хирургии колеблется от 19,7 до 23,1 %. Периоперационная инфузионная терапия является динамичным процессом дооперационной ликвидации гиповолемии, интраоперационной поддержки эффективного объема циркулирующей крови и его послеоперационной стабилизации и влияет на развитие послеоперационных осложнений, длительность стационарного лечения и уровень летальности. Поиск проводился по ключевым словам в базах данных Scopus, Web of Science, MedLine, The Cochrane Library.

Treatment of abdominal pathology in 80 % cases is conducted surgically. According to the data of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD, 2016), postoperative lethality at non-urgent surgical interventions makes up 4 %, in urgent surgery ranges from 19.7 to 23.1 %. Perioperative fluid therapy is a dynamic process of perioperative eradication of hypovolemia, intra-operative support of effective volume of circulatory blood and its postoperative stabilizing. The liberal mode of perioperative fluid therapy is directed to achieve the hypervolemic hemodilution, is characterized by positive water balance and forms acute hypervolemia, causes the threat of development of interstitial edema of tissues, multiple organ dysfunction of failure. Restrictive mode of fluid therapy allows eradicate hypovolemia under the conditions of normovolemia or “zero water balance”, reduces the threat of surplus liquid, development of interstitial edema and multiple organ dysfunction or failure, reduces the number of postoperative complications, period of gastrointestinal tract recovery, duration of in-hospital treatment of patients. The targeted mode of fluid therapy optimizes tissue perfusion by a target management of hemodynamic parameters, reduces duration of in-hospital treatment of patients and level of lethality allowing to support the patient’s growing requirement in oxygen. The analysis of literature data showed absence of the concerted recommendations and algorithms on relatively objective prescriptions to the certain mode of fluid therapy depending on a surgical risk and urgency of surgical intervention, calculation of necessary volume of fluid therapy regarding the stage of perioperative period.


Keywords

періопераційна інфузійна терапія; ліберальний режим; рестриктивний режим; цілеспрямований режим; огляд

периоперационная инфузионная терапия; либеральный режим; рестриктивный режим; целенаправленный режим; обзор

perioperative fluid therapy; liberal mode; restrictive mode; targeted mode; review


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