Optimizing restoration of intestinal function in moderate-risk surgical patients with abdominal emergencies using different infusion therapy regimens
DOI:
https://doi.org/10.14739/2310-1210.2020.6.218445Keywords:
urgent surgery, infusion therapy, postoperative intestinal obstruction, intraabdominal hypertension, sonographic diagnosticsAbstract
The aim of the study was to evaluate the effectiveness of liberal and restrictive regimens of infusion therapy based on a comparative analysis of the postoperative bowel motor function recovery in moderate-risk surgical patients with abdominal emergencies.
Materials and methods. In a prospective study, 70 patients with emergency pathology of the abdominal cavity were randomly examined, urgently operated by laparotomy. Perioperative infusion therapy was performed in the liberal (n = 35) and restrictive (n = 35) regimens. The volume of body water sectors was determined rheographically and the interstitium volume was calculated. Intestinal function was assessed physically, by measuring the residual gastric volume and intraabdominal pressure, and the intestinal wall sonographic visualization.
Results. In patients with abdominal emergency receiving the liberal regimen of perioperative infusion therapy, an interstitial edema development was found (P < 0.001). This correlated with an increase in diameter (R = 0.78, P = 0.02) and intestinal wall thickness (R = 0.86, P = 0.02) and was accompanied by I degree intra-abdominal hypertension development from the 1st to the 5th day. A low motor-evacuation function of the stomach was clinically observed up to the 3rd day, the paradoxical pendular peristalsis was up to the 5th day. Intestinal motor-evacuation function was restored in 49 % of patients from the 7th day. In the restrictive regimen of infusion therapy, the physiological interstitial volume was preserved with an increased wall thickness (P < 0.02) and diameter (P < 0.001) of the small intestine on day 1 and 3 after surgery without signs of intraabdominal hypertension. The motor-evacuation function of the stomach was restored in 85 % of patients from the 3 day, and of the intestine – in 79 % of patients from the 5th day.
Conclusions. The perioperative liberal regimen of infusion therapy in moderate-risk surgical patients with abdominal emergencies is accompanied by interstitial intestinal edema, I degree intraabdominal hypertension, longer recovery time of postoperative intestinal failure up to the 7 day after surgery. The restrictive regimen of infusion prevents the development of interstitial edema and intraabdominal hypertension, helps to reduce the time for the motor-evacuation function of the gastrointestinal tract full recovery up to 5 days.
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