DOI: https://doi.org/10.22141/2224-0586.8.103.2019.192376

The influence of hemofiltration on the general status of cancer patients after multi-organ operations

M.V. Krasnoselskiy, Ye.M. Krutko, R.E. Khramtsov

Abstract


Background. The purpose was to study the method of hemofiltration in patients after multiple surgical interventions. Materials and methods. The clinical part of the work was done during the clinical and physiological examination and treatment of 39 patients aged 19–75 years (median 52 years) after multiple surgical interventions. The patients were divided into 2 groups. The first (comparison) group included 23 patients with multi-organ interventions, who received common intensive care. The second (main) group included 16 patients with multi-organ surgical interventions, in whom hemofiltration technique was used as a part of comprehensive intensive care. Acute Physiology And Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Glasgow Coma Scale were used to determine clinical and laboratory parameters, which are necessary to assess the severity of patient’s state. Results. To evaluate the clinical effectiveness of comprehensive intensive care with hemofiltration, ove­rall clinical, biochemical and immunological parameters were studied, which were probably related to the outcome of underlying disease in the dynamics from day 1 to day 7 of treatment of cancer patients at the department of anesthesiology and intensive care, with assessment of mortality during hospital stay. The effect of continuous hemofiltration on the central nervous system from day 1 to day 7 was evaluated using GCS. In patients of the main group, the initial level of consciousness was 11.5 ± 2.7 points, which clinically corresponded to sopor — stunning. On the second day of the treatment, the level of consciousness was 12.1 ± 2.3 points, from the 3rd to the 7th day, there was a significant (p < 0.05) increase to 14.5 ± 1.5 points, which clinically corresponded to a moderate stunning. In the comparison group of patients, the initial degree of depressed consciousness was probably (p < 0.01) higher — 7.8 ± 2.5 points, which clinically corresponded to a deep sopor — coma I, remaining at this level up to day 3 — 7.5 ± 1.5 points. From the 3rd to the 7th day, against deterioration and progression of the multiple organ dysfunction syndrome (MODS), the level of consciousness significantly (p < 0.05) reduced and was 6.0 ± 1.5 points that clinically corresponded to coma II. The impact of continuous hemofiltration on the severity of MODS during its conduction from the 1st to the 7th day was assessed using the SOFA. In patients of the main group, the severity of the state and the seve­rity of MODS on the SOFA in the first day of continuous hemofiltration was 12.9 ± 3.3 points with a significant (p < 0.05) decrease to day 3 up to 10.3 ± 2.1 point, and to day 7 — up to 7.1 ± 2.3 points. Clinically, it was characterized by stabilization of the state and regression of the manifestations of MODS, primarily stabilization, starting from day 2, of the indicators of central hemodynamics, gas exchange function of the lungs and level of consciousness. In the comparison group, the severity of the condition on the SOFA on the first day of treatment was higher compared to patients who survived — 13.1 ± 2.3 points, but these differences were not significant (p > 0.05). In the dynamics, from the second day of observation, against the background of MODS progression and, first of all, hemodynamic indicators, there was a significant (p < 0.05) deterioration in the severity of the condition up to 16.5 ± 2.0 points, and on the se­venth day — up to 19.0 ± 1.0 points. Conclusions. Due to the use of hemofiltration as a part of intensive care and its effect on the severity of the state on the SOFA and GCS, the severity of the disease reduced by 1.2 times. The proposed method of hemofiltration has allowed us to reduce the number of postoperative purulent-septic complications in the main group by 1.4 times and the risk of the multiple organ dysfunction syndrome — by 33.8 % in the main group versus the comparison group.


Keywords


hemofiltration; multi-organ operations; cancer patients

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