SYSTEM OF ANAESTHETIC SUPPORT AT LARGE JOINT REPLACEMENT SURGERIES
Rubrics: TRAUMATOLOGY
Authors:
1.
Irkutsk, Irkutsk region, Russian Federation
2.
Irkutsk, Irkutsk region, Russian Federation
3.
Irkutsk, Irkutsk region, Russian Federation
4.
Irkutsk, Irkutsk region, Russian Federation
5.
Irkutsk, Irkutsk region, Russian Federation
6.
Irkutsk, Irkutsk region, Russian Federation
7.
Irkutsk, Irkutsk region, Russian Federation
8.
Irkutsk, Irkutsk region, Russian Federation
9.
Irkutsk, Irkutsk region, Russian Federation
Type:
Article
Pages:
from 59
to 63
Status:
Published
Received:
14.11.2017
Accepted:
30.11.2017
Published:
30.11.2017
Subject area:
UDK 61 Медицина. Охрана здоровья
Language:
Russian
Keywords:
endoprotezirovanie krupnyh sustavov, sistema anesteziologicheskogo obespecheniya, subarahnoidal'naya anesteziya, zhirovaya globulemiya, trombogennye oslozhneniya
Abstract (English):
Vypolnenie operaciy total'nogo endoprotezirovaniya krupnyh sustavov sopryazheno s neskol'kimi anesteziologicheskimi problemami, reshenie kotoryh obespechivaet bezopasnost' vypolneniya etih vysokotravmatichnyh operaciy i trebuet resheniya sleduyuschih anesteziologicheskih zadach v perioperacionnom periode: vysokaya stepen' antinociceptivnoy zaschity pacientov s effektivnoy relaksaciey zony operativnogo vmeshatel'stva; profilaktika zhirovoy giperglobulemii; snizhenie ob'ema perioperacionnoy gemorragii i profilaktika trombogennyh oslozhneniy. Razrabotana sobstvennaya programma anesteziologicheskogo obespecheniya pri protezirovanii krupnyh sustavov, komponentami kotoroy yavlyayutsya: vid obezbolivaniya – subarahnoidal'naya anesteziya s sohranennym spontannym dyhaniem pacienta; sobstvennyy sposob profilaktiki zhirovoy globulemii, osnovannyy na sohranenii funkcional'noy stabil'nosti gepatocita; sobstvennyy sposob vospolneniya perioperacionnoy krovopoteri, osnovannyy na dopolnitel'nom principe «normalizaciya onkoticheskogo davleniya krovi». Do nachala operacii pacienty poluchayut rastvor traneksamovoy kisloty v doze 10 mg/kg massy dlya ingibirovaniya sobstvennogo proteoliza (tehnologiya krovosberezheniya). Etot priem obespechivaet «suhoe» operacionnoe pole, umen'shaya intraoperacionnuyu gemorragiyu. V rannem posleoperacionnom periode (cherez 5 chasov posle zaversheniya operacii) pod kontrolem vremeni svertyvaniya cel'noy krovi pacienty poluchayut nizkomolekulyarnyy geparin kleksan v lechebnoy dozirovke 1 mg/kg massy. Eto obespechivaet effektivnuyu profilaktiku trombogennyh oslozhneniy. Primenenie razrabotannoy metodiki pokazyvaet ee vysokuyu klinicheskuyu effektivnost'. Za poslednie 5 let vypolneno 5800 operaciy po protezirovaniyu krupnyh sustavov, v tom chisle 3200 operaciy total'nogo endoprotezirovaniya tazobedrennogo sustava (TETS), 2600 operaciy total'nogo endoprotezirovaniya kolennogo sustava (TEKS). Oslozhneniy s letal'nym ishodom ne bylo, v 5 sluchayah byla otmechena zhirovaya giperglobulemiya, kotoraya kupirovana sobstvennym sposobom lecheniya. Trombogennyh oslozhneniy ne zaregistrirovano.
Vypolnenie operaciy total'nogo endoprotezirovaniya krupnyh sustavov sopryazheno s neskol'kimi anesteziologicheskimi problemami, reshenie kotoryh obespechivaet bezopasnost' vypolneniya etih vysokotravmatichnyh operaciy i trebuet resheniya sleduyuschih anesteziologicheskih zadach v perioperacionnom periode: vysokaya stepen' antinociceptivnoy zaschity pacientov s effektivnoy relaksaciey zony operativnogo vmeshatel'stva; profilaktika zhirovoy giperglobulemii; snizhenie ob'ema perioperacionnoy gemorragii i profilaktika trombogennyh oslozhneniy. Razrabotana sobstvennaya programma anesteziologicheskogo obespecheniya pri protezirovanii krupnyh sustavov, komponentami kotoroy yavlyayutsya: vid obezbolivaniya – subarahnoidal'naya anesteziya s sohranennym spontannym dyhaniem pacienta; sobstvennyy sposob profilaktiki zhirovoy globulemii, osnovannyy na sohranenii funkcional'noy stabil'nosti gepatocita; sobstvennyy sposob vospolneniya perioperacionnoy krovopoteri, osnovannyy na dopolnitel'nom principe «normalizaciya onkoticheskogo davleniya krovi». Do nachala operacii pacienty poluchayut rastvor traneksamovoy kisloty v doze 10 mg/kg massy dlya ingibirovaniya sobstvennogo proteoliza (tehnologiya krovosberezheniya). Etot priem obespechivaet «suhoe» operacionnoe pole, umen'shaya intraoperacionnuyu gemorragiyu. V rannem posleoperacionnom periode (cherez 5 chasov posle zaversheniya operacii) pod kontrolem vremeni svertyvaniya cel'noy krovi pacienty poluchayut nizkomolekulyarnyy geparin kleksan v lechebnoy dozirovke 1 mg/kg massy. Eto obespechivaet effektivnuyu profilaktiku trombogennyh oslozhneniy. Primenenie razrabotannoy metodiki pokazyvaet ee vysokuyu klinicheskuyu effektivnost'. Za poslednie 5 let vypolneno 5800 operaciy po protezirovaniyu krupnyh sustavov, v tom chisle 3200 operaciy total'nogo endoprotezirovaniya tazobedrennogo sustava (TETS), 2600 operaciy total'nogo endoprotezirovaniya kolennogo sustava (TEKS). Oslozhneniy s letal'nym ishodom ne bylo, v 5 sluchayah byla otmechena zhirovaya giperglobulemiya, kotoraya kupirovana sobstvennym sposobom lecheniya. Trombogennyh oslozhneniy ne zaregistrirovano.
Keywords:
endoprotezirovanie krupnyh sustavov, sistema anesteziologicheskogo obespecheniya, subarahnoidal'naya anesteziya, zhirovaya globulemiya, trombogennye oslozhneniya
endoprotezirovanie krupnyh sustavov, sistema anesteziologicheskogo obespecheniya, subarahnoidal'naya anesteziya, zhirovaya globulemiya, trombogennye oslozhneniya
1. Sistema anesteziologicheskogo obespecheniya
