ИНТРАОПЕРАЦИОННАЯ ДИНАМИКА КИСЛОРОДНОГО БАЛАНСА У ПОСТРАДАВШИХ С ПОВРЕЖДЕНИЯМИ ОРГАНОВ БРЮШНОЙ ПОЛОСТИ, ОСЛОЖНЕННЫМИ ОСТРОЙ МАССИВНОЙ КРОВОПОТЕРЕЙ

Abstract

Objective: to analyze the oxygen balance in patients with injuries of abdominal cavity organs and acute blood loss during the operation and arrest of bleeding. Material and methods: the study group included 50 patients (49 men and 1 woman, average age 33 (25,75; 44,5) years old) suffered from injuries of abdominal cavity organs complicated by acute massive blood loss requiring emergency surgical intervention. The severity of patients’ state was 38 (27,75; 48) scores according to ISS. The investigators examined the following parameters: volume of blood loss, hemoglobin (Hg) level, hematocrit (HCT), blood gas composition, indices of oxygen balance, acid-base balance, electrolytes level, and tissue metabolism status. The continuous minimally invasive evaluation of central hemodynamics parameters was conducted. The statistical analysis of received data was performed using SPSS software (SPSS Inc., USA). Results: the parameters of central hemodynamics were not representative of the severity of patients’ state at their admission into operative theatre. The signs of hypovolemia were observed along with normal vascular tone and cardiac output. Meanwhile such parameters of oxygen balance as high oxygen consumption index (VO 2 I) and oxygen extraction ratio (О 2 ER) as well as low central venous saturation (SvО 2 ) confirmed the critical state of patients. These data testified that patients suffered from severe incident of respiratory or circulatory hypoxia during trauma, which had been corrected during first aid treatment and transportation until patient’s admission into operative theatre, so patients had laboratory findings of «oxygen debt». The high values of VO 2 I accompanied by increase of О 2 ER were still observed at the end of surgery while the low values of CvO 2 , PvO 2 and SvО 2 testified the continuous circulatory hypoxia. Conclusion: All patients with postoperative complications suffered from severe disturbances of oxygen delivery during preoperative period. The low cardiac efficiency was the main reason for ongoing state of shock at such patients. The correlation between postoperative lethal outcomes and the value of cardiac index (CI) at the end of surgery in such group of patients was revealed.