Modern aspects of the volemic management of patients with acute abdominal pathology.
DOI:
https://doi.org/10.26641/2307-0404.2018.4(part1).145675Keywords:
perioperative infusion therapy, liberal regime, restrictive regime, goal directed therapyAbstract
In conditions of urgent surgical care, the age of patients, concomitant somatic chronic pathology are factors that significantly increase the risk of postoperative complications and lethality. The latter in this group of patients is 30-80% and is associated with the development of hypovolemia. Treatment of the latter is traditionally provided by the routine conduct of a liberal regimen of infusion therapy (IT) to achieve hypervolemic hemodilution by infusion of crystalloid and colloidal drugs. It was found that the consequences of the liberal regime of IT is the development of acute hypervolemia. The accumulation of excess fluid forms the development of interstitial edema of tissues, causing a decrease in tissue oxygenation, the development of coagulation disorders and multi-organ dysfunction ̸ inadequacy, inhibits the healing of wounds. Therefore, in recent years, a restrictive (restricted) IT regimen has become available for clinical use, the goal of which is to achieve normovolemia. At the same time, evidence-based clinical studies indicate the possibility of using perioperative optimization of hemodynamics in the clinic by individualizing IT in accordance with the indices of central hemodynamics.
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