Kursov S. Intensive care of hydrodynamic failures and multiple organ failure at the patients with abdominal sepsis

The dissertation deals with the problem of hydrodynamic failure correction with the patients with abdominal sepsis. While carrying out the investigation, 244 patients with abdominal sepsis were examined and divided into 12 groups depending on the value of a starting estimation of the state severity according to Acute Physiology And Chronic Health Evaluation-II and on the composition of a fluid resuscitation. As the means of fluid resuscitation we used only crystalloid solutions or their compounds with the derivatives of a 4% modified gelatine (MFG) and 6% hydroxyethylstarch (HES) 200/0.5 and 130/0.42. The doses of synthetic colloid plasma substitutes with the patients of 1-4 groups were 10.0±1.0 ml/kg in 24 hours whereas with the patients of 5-12 groups - 15.0±2.0 ml/kg in 24 hours. We revealed that with the patients with the state severity estimation not more than 10 points, the resuscitation with crystalloids only is highly competitive with the resuscitation with colloid addition. With more severe patients the addition of colloids provided for reliable better indices of central hemodynamics, more efficient elimination of oxygen debt and a faster normalization of the state of water areas and sections of a body because of the reduction of the syndrome of capillary leak manifestation. The excess of a fluid in the interstitial area appears on the second day after the operation, on the third day it got its maximum and within the following fourth-fifth day gradually regressed. The syndrome of capillary leak was revealed with every patient. The composition of fluid resuscitation influenced its severity greatly. The addition of colloid solutions in a dose of 15.0±2.0 ml/kg in 24 hours into the composition of fluid resuscitation contributed to the precautions and the decrease of breath dysfunction manifestation, to the increase of an extensional renal blood current, microcirculation improvement and the removal of nitrous slags from a body, as well as limited the severity of abdominal compartment-syndrome course. The usage of colloid solutions in a dose of 15.0±2.0 ml/kg in 24 hours was associated with the mortality decrease. The 6% solutions of HES were of advantage. Their usage provided for better indices for the least patients mortality degree.