DOI: https://doi.org/10.22141/2224-0586.4.99.2019.173933

Evaluation of baseline pathophysiological changes in patients with emergency abdominal pathology

O.V. Kravets

Abstract


Background. Acute surgical pathology is associated with high rates of postoperative complications and mortality. The aim is to determine baseline pathophysiological changes in patients with acute abdominal pathology and their dependence on the grade of surgical risk. Materials and methods. We examined 200 patients with urgency laparotomy. We have divided the patients into two groups (according to the surgical risk score — P-POSSUM), namely moderate (n = 100) and high (n = 100) surgical risk. We measured routine clinical laboratory characteristics, central hemodynamic state and  fluid compartments of the body by the noninvasive bioelectric integral evaluation of the body structure with the Diamant monitor complex. Results. We found significant decrease of extracellular volume due to reduction of plasma volume (83 % of the norm (p < 0.05) in the 1st group, 86 % of the norm (p < 0.05) in the 2nd group); and dehydration was not defined. All patients had adaptive hemodynamic response. The 1st group was found to have decline in stroke volume by 10 % (p < 0.05) due to hypovolemia. We fixed a decrease of stroke volume index by 122 % of the norm (p < 0.05), which was compensated with moderate tachycardia and formed relative hyperdynamia (cardiac output was 107 % of the norm (p < 0.05)) for the 1st group. As a result, tissue perfusion complied with the standard rate. The relative hypodynamia was determined in the 2nd group (cardiac output was 84.6 % of the norm (p < 0.05)) despite tachycardia (heart rate was 45 % over the norm (p < 0.05)) and vasospasm (systemic vascular resistance was 184 % of the norm (p < 0.05)) while tissue perfusion decreased (peripheral perfusion index accounted for 81.3 % of the norm (p < 0.05)). Conclusions. Acute surgery pathology under II rate of dehydration forms the moderate vоlumе dеplеtion/hypovolemia, causes redistribution of extracellular fluid volume. Hypovolemia also deals with loss of plasma volume and causes development of hemodynamic disorder and water redistribution between body sectors. Severity of pathophysiological abnormality depends on the patient’s surgical risk degree. Compensatory raise of heart rate forms relative hyperdynamia and preserves tissue perfusion in patient of moderate surgical risk. Pathognomic development of tachycardia and vasospasm forms relative hypodynamic and tissue perfusion decrease, which is relevant for patient of high surgical risk.


Keywords


emergency abdominal pathology; surgical risk; fluid compartments; central hemodynamics; hypovolemia

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O.V. Kravets

State Institution ‘Dnipropetrovsk medical academy of the Ministry of Health of Ukraine’

Department of Anesthesiology, Intensive Therapy and Medicine of emergency conditions of Postgraduate Education Faculty

Evaluation of baseline pathophysiological changes in patients with emergency abdominal pathology

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