Effect of hypertonic-hyperoncotic solution infusion on tissue perfusion during surgical treatment of the abdominal aorta

Ljiljana Soskic, Lazar Davidovic, Biljana Milicic, Mladen Kocica, Natasa Kovacevic, Tijana Simic
2007 Vojnosanitetski Pregled  
Klinički centar Srbije, Institut za kardiovaskularne bolesti, Odeljenje anestezije i reanimacije, Beograd Apstrakt Uvod/Cilj. Smanjenje arterijskog protoka ispod kritičnog nivoa dovodi do edema endotela kapilara i daljeg pogoršanja perfuzije tkiva. Infuzija hipertonog rastvora blago i kratkotrajno povećava osmolalnost plazme, a koloidni rastvori produžuju taj efekat. Cilj rada bio je da se ispita uticaj hipertono-hiperonkotskog rastvora (HH) na perfuziju organa tokom rekonstrukcije abdominalne
more » ... ukcije abdominalne aorte (AA). Metode. Studijom je bilo obuhvaćeno 40 bolesnika podvrgnutih rekonstrukciji AA zbog aneurizme ili Leriche sindroma. Klema na aortu im je postavljana poprečno, ispod ishodišta bubrežnih arterija. Prema vrsti rastvora koji su dobijali dok je klema bila na aorti bolesnici su podeljeni u dve grupe sa po 20 bolesnika: ispitivana grupa (A) − primala je 4 ml/kg rastvora (7,2% NaCl/10% dekstran) i kontrolna grupa (B) − primala je 0,9% NaCl. Iz studije su izuzeti bolesnici čiji je preoperativni nivo kreatinina bio veći od 139 μmol/l, a ejekciona frakcija srca manja od 40%. Rezultati. Saturacija mešane venske krvi kiseonikom povećala se od 73,3±7,33% do 74,95±6,19% u grupi A, dok je u grupi B opala sa 65,35±10,39% na 62,65±10,42% (p = 0,001). Količina dopremljenog kiseonika u grupi A značajno se povećala od 684,44±244,34 ml/min na 1362,45±2351,01 ml/min, dok je u grupi B opala sa 668,2±382,12 ml/min na 651,7±313,98 ml/min (p = 0,016). Alveolo-arterijska razlika kiseonika se u grupi A smanjila sa 23,12±14,74 mmHg na 21,1±10 mmHg, dok je u grupi B porasla od 23,79±15,22 mmHg na 26,33±13,78 mmHg (p = 0,05). Zaključak. Zadovoljavajuća perfuzija organa tokom operacije na AA postiže se i HH rastvorom i izotonim rastvorom. Zbog održavanja optimalnih vrednosti minutnog volumena srca, saturacije mešane venske krvi kiseonikom i alveolo-arterijske razlike kiseonika, HH rastvor se preporučuje za reanimaciju bolesnika kod declamping šoka (šoka nastalog nakon skidanja kleme). Ključne reči: aorta, abdominalna; hirurgija, rekonstruktivna, procedure; lečenje tečnostima; infuzije, parenteralne; rastvor natrijum hlorida, hipertonični; dekstrani. Abstract Background/Aim. Decreasing of arterial flow below the critical level leads to capillary endothelium edema and to further worsening of tissue perfusion. Hypertonic solution infusion provides mild and short plasma osmolality increasing, while colloidal solutions intensify that effect. The aim of this study was to investigate the effect of hypertonic-hyperoncotic solution (HH) on the organs perfusion during reconstructive surgical procedure on the abdominal aorta (AA). Methods. The study included 40 patients submitted to AA reconstruction due to aneurysm or Leriche's syndrome. A clamp was put transversally to the aorta, under the outlets of the renal arterias. According to the solution received when a clamp was on the aorta, the patients were divided into two groups containing 20 patients each: the tested group (A) which received 4 ml/kg of the solution (7.2% NaCl/10% dextran), and the control group (B) which received 0.9% NaCl. The study excluded the patients with the preoperative creatinine level more than 139 μmol/l, and ejection heart fraction less than 40%. Results. The mixed venous blood oxygen saturation increased from 73.3±7.33 to 74.95±6.19% in the group A, while it decreased from 65.35±10.39 to 62.65±10.42% in the group B (p = 0.001). The quantity of the provided oxygen in the group A increased significantly from 684.44±244.34 to 1362.45±2351.01 ml/min, while it decreased from 668.2±382.12 to 651.7±313.98 ml/min in the group B (p = 0.016). Alveolo-arterial difference in oxygen decreased from 23.12±14.74 to 21.1±10 mmHg in the group A, while it increased from 23.79±15.22 to 26.33±13.78 mmHg in the group B (p = 0.05). Conclusion. Satisfactory perfusion of organs during the AA surgery is obtained by using both HH and an isotonic solution. Due to maintaining the optimal values of the minute heart volume, saturation of vein blood blended with oxygen, and alveolo-arterial difference in oxygen, it is recommended to use HH solution for reanimation of patients in declamping shock.
doi:10.2298/vsp0710685s pmid:18041570 fatcat:cpcpkqfxkbbeddxnk36kwtw2mq