zdorПроблемы здоровья и экологииHealth and Ecology Issues2220-09672708-6011Gomel State Medical University10.51523/2708-6011.2023-20-3-03zdor-2585Research ArticleКЛИНИЧЕСКАЯ МЕДИЦИНАCLINICAL MEDICINEКумулятивный баланс жидкости в послеоперационном периоде абдоминальных хирургических вмешательствCumulative fluid balance in the postoperative period of abdominal surgeryhttps://orcid.org/0000-0003-1659-5902ТочилоС. А.TachylaS. A.

Точило Сергей Анатольевич, к.м.н., доцент, врач анестезиолог-реаниматолог отделения анестезиологии и реанимации; заведующий филиалом кафедр анестезиологии и реаниматологии с курсом ФПК и ПК и госпитальной хирургии с курсом ФПК и ПК

г. Могилев

г. Витебск

Siarhei A. Tachyla, Candidate of Medical Sciences, Associate Professor, Anesthesiologist-Resuscitator, Department of Anesthesiology and Intensive Care; Head of the Branch of the Department of Anesthesiology and Intensive Care with the course of the Faculty for Advanced Training & Retraining and the Head of Hospital Surgery with the course of the Faculty for Advanced Training & Retraining

Mogilev

Vitebsk

tsa80@inbox.ruhttps://orcid.org/0000-0001-5092-8315МарочковА. В.MarochkovA. V.

Марочков Алексей Викторович, д.м.н., профессор, врач анестезиолог-реаниматолог отделения анестезиологии и реанимации; профессор филиала кафедр анестезиологии и реаниматологии с курсом ФПК и ПК и госпитальной хирургии с курсом ФПК и ПК

г. Могилев

г. Витебск

Alexey V. Marochkov, Doctor of Medical Sciences, Anesthesiologist-Resuscitator, Department of Anesthesiology and Intensive Care; Professor of the affiliate of the Chair of Anesthesiology and Intensive Care with the course of the Faculty for Advanced Training & Retraining and the Chair of Hospital Surgery with the course of the Faculty for Advanced Training & Retraining

Mogilev

Vitebsk

marochkov@mail.ruhttps://orcid.org/0000-0002-4426-0213КлепчаТ. И.KlepchaT. I.

Клепча Татьяна Ивановна, врач анестезиолог-реаниматолог отделения анестезиологии и реанимации Центра сердечно-сосудистой хирургии

г. Могилев

Tatsiana I. Klepcha, Anesthesiologist-Resuscitator, Department of Anesthesiology and Intensive Care of the Center for Cardiovascular Surgery

Mogilev

tatsianaklepcha@gmail.comhttps://orcid.org/0000-0001-8953-8533ЛивинскаяВ. А.LivinskayaV. A.

Ливинская Виктория Александровна, к.ф.-м.н., доцент кафедры «Финансы и бухгалтерский учет»

г. Могилев

Viktoriya A. Livinskaya, Candidate of Physical and Mathematical Sciences, Associate Professor of the Department of Finance and Accounting

Mogilev

vita_liv@tut.byМогилевская областная клиническая больница; Витебский государственный ордена Дружбы народов медицинский университетMogilev Regional Clinical Hospital; Vitebsk State Order of Peoples’ Friendship Medical UniversityМогилевская областная клиническая больницаMogilev Regional Clinical HospitalБелорусско-Российский университетBelarusian-Russian University2023260920232031928Copyright © Точило С.А., Марочков А.В., Клепча Т.И., Ливинская В.А., 20232023Точило С.А., Марочков А.В., Клепча Т.И., Ливинская В.А.Tachyla S.A., Marochkov A.V., Klepcha T.I., Livinskaya V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.gsmu.by/jour/article/view/2585

Цель исследования. Определить оптимальный кумулятивный баланс жидкости у пациентов в послеоперационном периоде абдоминальных хирургических вмешательств.Материалы и методы. Проанализированы объемы введенной и удаленной жидкости, баланс жидкости, кумулятивный баланс жидкости в течение 5 суток и его взаимосвязь с летальностью у 143 пациентов после абдоминальных хирургических вмешательств, которым проводилось лечение в отделении анестезиологии и реанимации. Выделено две группы пациентов: 1-я (n = 86) — без сепсиса, 2-я (n = 57) — с наличием сепсиса. В 1-й группе умерших не было, во 2-й группе умерли 11 пациентов (19,3 %).Результаты. У пациентов 2-й группы в первые сутки отмечался положительный баланс жидкости в объеме 1,55 (1,2; 2,4) л, что значимо больше, чем у пациентов 1-й группы — 1,1 (0,4; 1,8) л (р = 0,0016). На последующих этапах баланс жидкости у пациентов в исследуемых группах не различался. Установлены оптимальные границы для поддержания кумулятивного баланса жидкости на протяжении 5 суток у пациентов 2-й группы в послеоперационном периоде хирургических вмешательств: менее 5,6 л или менее 8 % массы тела пациента. Превышение кумулятивного баланса жидкости за 5 суток выше 5,6 л или более 8 % массы тела приводило к значимому увеличению риска летального исхода среди пациентов 2-й группы: отношение шансов (ОШ) — 1,39 (p < 0,01) и 1,24 (p < 0,01) соответственно.Заключение. Выделены особенности баланса жидкости у пациентов с сепсисом в послеоперационном периоде абдоминальных хирургических вмешательств.

Materials and methods. To analyze the volumes of administered and removed fluid, fluid balance, cumulative fluid balance during 5 days and its relationship with mortality in 143 patients after abdominal surgical interventions who were treated in the department of anesthesiology and intensive care. Two groups of patients were identified: 1st (n = 86) - without sepsis, 2nd (n = 57) - with the presence of sepsis. There were no deaths in group 1, 11 patients (19.3%) died in group 2.Results. The patients of the 2nd group had a positive fluid balance in the volume of 1.55 (1.2; 2.4) liters on the first day, which was significantly greater than in the patients of the 1st group - 1.1 (0.4; 1.8) liters (p = 0.0016). At the subsequent stages, the fluid balance in patients in the studied groups did not differ. The optimal limits for maintaining the cumulative fluid balance during 5 days in patients of the 2nd group in the postoperative period of surgical interventions were established: less than 5.6 liters or less than 8 % of the patient’s body weight. Exceeding the 5-day cumulative fluid balance above 5.6 liters or more than 8 % of body weight resulted in a significant increase in the risk of mortality among patients in group 2: odds ratio (OR) - 1.39 (p < 0.01) and 1.24 (p < 0.01), respectively.Conclusion. The features of fluid balance in patients with sepsis in the postoperative period of abdominal surgical interventions are highlighted.

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The authors declare that there are no conflicts of interest present.