The functional state of the kidneys and circulatory system was first studied in patients with fluid resuscitation and dopaminergic support in patients with SIRS and sepsis (severe). The obtained results open up the idea of new mechanisms of regulation of homeostasis, which are leading in the development of multiple organ damage in patients with sepsis, including dopamine-dependent compensated sepsis-induced hypotension.
Subject to the application and study of the action of the basic components of intensive care, namely infusion therapy solutions (Ringer’s solution, Rheosorbylact), changes were first recorded that are responsible for the level of their compensatory direction and, in turn, determine the modes of infusion therapy as test systems for assessing the state of water salt metabolism, circulatory system, endotoxemia.
As a result of using this methodology, new data were obtained that significantly complement existing views on the course of sepsis. In particular, in patients with dopamine-dependent compensated sepsis-induced hypotension (DDCSIH), the effect of suppressing volume-regulating renal function (sodium clearance by 19-20%, p <0.05) was recorded. The basis of these disorders is the lower value of the index of the filtration fraction. Also, in these patients, a decrease in blood purification from toxic substances is detected according to the signs of a reaction of unicellular receptor systems (by 49.8%; P <0.05, compared with control values), and toxemia with activation the functioning of active nephrons has a productive-retention genesis.
The course of sepsis is characterized by depression of contractile activity of the myocardium and, with compensated dopamine-dependent sepsis-induced hypotension, a decrease in the reserve potential of mechanisms that ensure constant circulation.
It has been established that one of the indicators for assessing the state of baroreflex regulation, the volume-regulating function of the circulatory system in patients with SIRS and DDCSIH, provided that the volume of extracellular space increases, is the pressure-corrected frequency. Among the dysregulatory changes in patients with DDCSIH in response to an increase in the extracellular space, there is a depression of the baroreflex regulation of the volume-regulating function of the circulatory system and contractile activity of the myocardium. When DDCSIH in patients with purulent-septic complications in the study of the microvasculature of the sublingual area revealed microcirculatory disorders, characterized by deformation of the vascular bed in terms of the index of heterogeneity of blood flow, density and function of the vessels placed, quality of blood supply.
It has been studied that the compensatory mechanisms that occur at the nephron level during DDCSIH, are mainly focused on reducing water and sodium reabsorption (during infusion of Ringer’s solution), increasing glomerular filtration rate, sodium filtration fraction and reducing water and sodium reabsorption (during infusion of rheosorbylact) under standard load. Changes in the osmoregulatory function of the kidneys in patients with DDCSIH with extracellular space volume increase with Ringer’s solution or Rheosorbylact are characterized by an increase in the clearance of osmotically active substances (96 ± 23.4% (Δ, p <0.05) and 240 ± 68.6% (Δ, respectively) , p <0.05)) with respect to the starting values. However, depression of osmoregulatory function of the kidneys is recorded, which after administration of Ringer’s solution is 34.8% (p <0.05), and after administration of rheosorbylact, it is 9.8% (p <0.05) compared with the control groups. Extracellular space volume increase with Ringer’s solution in patients with sepsis leads to an increase in the clearance of toxic substances, but the latter does not reach the value of the control group and does not detract from toxemia, which indicates an offset in the balance of toxin formation. According to the indicator of medium-mass molecules (MMM), extracellular space volume increase by Ringer’s solution increases clearance, which exceeds this value in patients of the control group by 62.0%. Extracellular space volume increase with Rheosorbylact solution in patients with sepsis leads to an increase in the clearance of toxic substances by 64.7% (p <0.05) more than after extracellular space volume increase with Ringer’s solution. This is achieved by the hard work of existing nephrons, in particular, in terms of the rate of excretion of toxic substances, standardized for glomerular filtration rate by 40.8% (p <0.05) more than after extracellular space volume increase with Ringer’s solution.
