Clinical efficacy of different infusion regimens in high surgical risk patients with urgent abdominal pathology
Keywords:urgent surgery, high surgical risk, regimen of infusion therapy, postoperative intestinal obstruction, intra-abdominal hypertension, sonographic diagnosis
Background. Long-term inpatient treatment and associated significant mortality are specifically attributed to urgent surgeries, 53 % of which are accounted for acute surgical pathology. The prolonged postoperative ileus is considered as one of the most severe complications. The purpose: to assess the efficacy of restrictive and goal-directed regimens of infusion therapy based on comparative analysis of clinical resolution of postoperative motor bowel disorders in high surgical risk patients with urgent abdominal pathology. Materials and methods. We examined 80 patients with urgent abdominal pathology. All patients underwent emergency laparotomy and were divided into 2 groups. In the first one (n = 40), the persons received goal-directed infusion therapy. The patients of the second group (n = 40) received infusion therapy in restrictive regimen. We measured fluid compartments of the body by the method of noninvasive bioelectrical impedance analysis of the body structure, function of gastrointestinal tract — by clinical implications, intra-abdominal pressure and ultrasound visualization of the intestinal wall condition. Results. Goal-directed infusion therapy formed the interstitial edema on the 1st day (p < 0.04), it correlated with an increase in the small intestine wall thickness (R = 0.86, p = 0.02), hyperextension of intestinal loops (R = 0.65, p = 0.02) and progression of intra-abdominal hypertension degree 1. Clinical recovery of gastric emptying occurred in 45 % patients within 5 postoperative days. In 55 % of patients, we observed prolongation of postoperative ileus. Restrictive regimen of infusion therapy was associated with physiological volume of interstitium during the whole period of observation, restoration of thickness (p < 0.02) and diameter (p < 0.01) of the small intestine from the 3rd day, absence of intra-abdominal hypertension signs. Autonomous defecation was observed from the 5th day in 70 % of patients. Conclusions. Goal-directed regimen of infusion therapy in high surgical risk patients with urgent abdominal pathology was accompanied by progression of interstitial edema on the 1st day, intra-abdominal hypertension degree 1 during two days, prolongation of postoperative ileus to the 7th day after surgery. Restrictive regimen of infusion in the perioperative period in high surgical risk patients with urgent abdominal pathology allows us to prevent the development of interstitial edema and intra-abdominal hypertension and reduce the terms of full recovery of gastric emptying to 5 days.
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