The dissertation presents a new solution to an actual scientific problem, namely, a mathematical model of the functional state of hemodynamics in patients with an increased body mass index during laparoscopic cholecystectostomy with various methods of anesthetic support was constructed for the first time.
The aim of the study is to improve the protocol of intraoperative intensive care in patients with an increased body mass index during laparoscopic cholecystectomy by evaluating the energy efficiency of blood circulation with different options for anesthetic support.
Patients were divided into 3 groups: Group I — 42 patients who underwent general intravenous anesthesia based on propofol through a perfusion system and fentanyl; II group, 42 patients, inhalation anesthesia based on sevoflurane using the low-flow method and fentanyl; Group III, 40 patients who, during surgery, were additionally added to the protocol of infusion therapy with a solution of D-fructose-1,6-diphosphate sodium salt hydrate intravenously, 150 mg/kg of ideal body weight at a rate of 10 ml per minute.
It was statistically proven that the additional introduction of D-fructose-1,6-diphosphate solution into the protocol of intraoperative infusion therapy increases the energy efficiency of blood circulation in most of the control points, namely: at the moment of induction, the perfusion index in groups I and III was 4, respectively. 4±0.1% and 4.8±0.2%, t 1.2 = 3.68; p 1.2 < 0.05; during intubation, the perfusion index in groups I and III, respectively, was 3.6±0.2% and 4.4±0.4%, t 1.2 = 4.18; p 1.2 < 0.05; with CO2 insufflation, the perfusion index in groups I and III was 3.9+0.1% and 4.8+0.1%, respectively, t 1.2 = 3.82; p 1.2 < 0.05; during CO2 desufflation, the perfusion index in groups I and III was 3.9+0.2% and 4.8+0.1%, respectively, t 1.2 = 4.11; p 1.2 < 0.05; 3 hours after surgery, the PI perfusion index in groups I and III was 4.1±0.2% and 4.7±0.2%, respectively, t 1.2 = 3.36; p 1.2 < 0.05.
Correlations were established between the level of the perfusion index and the dosage of propofol in patients of group I at the time of premedication, -0.42, induction -0.44, intubation -0.67, insufflation of CO2 - 0.72, desufflation of CO2 - 0, 76, 3 hours after surgery -0.61.
Correlations were established between the level of the perfusion index and the dosage of propofol in group III patients at the time of premedication, -0.32, induction -0.34, intubation -0.37, insufflation of CO2 -0.37, desufflation of CO2 -0, 31, 3 hours after the operation -0.34.
The data obtained during the correlation analysis of the level of the perfusion index with the level of adaptation to operative stress were statistically better, which confirms the method of anesthetic support for patients with obesity II degree during laparoscopic cholecystectomy using sevoflurane in combination with fentanyl as the option of choice, which confirmed by more stable energy efficiency of blood circulation during its use.
