Abstract
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.
Highlights
В экстренной хирургии острая кровопотеря остается основной причиной летальных исходов на операционном столе и в ближайшем послеопе рационном периоде [1—6, 28, 30—32, 40]
The average values of system hemodynamic parameters in patients with injuries of abdominal cavity organs complicated with massive hemorrhage did not reflect the severity of patients' state at admission into operating room
The hemodynam ic parameters have improved after surgical arrest of bleeding and intraoperative correction of hemor rhage. This means that heart rate (HR) approach the normal val ues, systolic BP and central venous pressure (CVP) values increase, cardiac index (CI) values remaine stable, increase of SVRI are becom ing evident the same time, indicating the exces sive increase of the vascular tone
Summary
В экстренной хирургии острая кровопотеря остается основной причиной летальных исходов на операционном столе и в ближайшем послеопе рационном периоде [1—6, 28, 30—32, 40]. В том числе при кровоте чении, достаточно хорошо изучена. Однако методы коррекции гиповолемии и острой анемии, а также их последствий (нарушение транспорта кислорода, гипоксия органов и тканей, перест ройка клеточного метаболизма и гибель клетки) продолжают обсуждаться в отечественной и зару бежной литературе [7—17, 26, 27, 35, 37—39, 45]. Концепция современной интенсивной тера пии критических состояний сформировалась в 1980—1990 е годы, когда стали возможными раз вернутые исследования центральной гемодина мики и кислородного обмена [18—25, 29, 33, 34, 36, 41—44]. И в настоящее время в до ступной отечественной и зарубежной литературе сведения об изменениях центральной гемодина мики, кислородного баланса и гомеостаза во вре мя экстренного хирургического лечения постра давших с массивной кровопотерей представлены недостаточно
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