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Section 6. Medical science
Azizova Farida Fakhitdin qizi, Assistant of Tashkent Institute of Postgraduate Medical Education
E-mail: evovision@bk.ru
Hemodynamic responses to rapid changes of intraabdominal pressure in patients with cholecystitis
Abstract: Increased intra-abdominal pressure leads to a decrease in cardiac index, giving tion-filling of the left ventricle of the heart and stroke index the background increase in total peripheral resistance. Parameter changes in blood pressure are also characterized by a tendency to increase.
Keywords: intra-abdominal pressure, laparoscopy, laporatomy.
There are many pathological states in abdominal surgery associated with the change of regime of intra-abdominal pressure: intestinal obstruction ofvarious origins, peritonitis, ascites, cancer, etc. [1; 2].At the same time increasing of intra-abdominal pressure plays, if not the leading role, also the competing role with key pathogenic factors in the pathogenesis of disorders of the vital systems of the body [3; 5].
Despite the diversity of mentioned the clinical situations, they have a common pathogenic factor — the high intra-abdominal pressure, therefore may have common mechanisms of development of deterministic symptoms and syndromes. Increasing of intra-abdominal pressure may be at different stages of treatment: in patients with intestinal obstruction — before surgery, in patients operated on for ventral hernias in the postoperative period, at a laparoscopy — intraoperatively. Detection of elevated intra-abdominal pressure as a major investigated pathogenic factor for different categories ofpa-tients, acting at different stages of treatment, allows to objectify the patterns of influence of increased IAP on the heart and blood vessels [4, 7].
Currently, the development of diagnostic equipment, opportunities of intraoperative monitoring allows plenty accurately assess changes in vital body functions in response to a particular pathogen. However, application of automated systems accumulation of and analysis using high statistics provides high conclusiveness of investigations
The purpose of research. The study of the hemodynamic profile of patients with cholecystitis, operated laparoscopically.
Results and discussion. Raised IAP and changing IAP were diagnosed on the basis of data obtained using a probe for gastric tonometry and, or in the direct measurement of IAP during laparo-
scopic procedures. The studies were conducted if there were fixed a pressure change > 10 mm. Hg.
The study group consisted of patients with cholecystitis operated laparoscopically. Pneumoperitoneum for laparoscopic manipulation accompanied by an increase IAP to 10-12 mm Hg. which registered with manometer of laparoscopic equipment. Patients were divided in powers of operational-anesthetic risk MSSAR-89, ASA, as well as the scale of Goldman's cardiac risk.
In all patients investigations were carried out in 3 stages: preoperative, intraoperative and postoperative period. The operation were determining factor in changing IAP in 3 main groups. — The patients which were operated laparoscopically had intraoperative IAP increase, due to the introduction of some gas volume inside of a closed abdominal space.
Condition of the central hemodynamics studied hardwaresoftware complex REODIN 500 SEC MEDASS on the following parameters: cardiac index; stroke index; total peripheral vascular resistance; left ventricular filling pressure; Heart rate. Cardiac index was also determined by Doppler device “ISKN”. The linear blood flow velocity was measured over the aortic arch. At the same time minute volume of blood flow was calculated by the formula: = Vlin IOC. * SA * 60/103 where Vlin — average linear velocity of flow (cm/sec) in the ascending aorta, SA — the cross sectional area of the aortic arch (cm2). SA determined from the nomogram Frucht, taking into account age, sex and weight [1]. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure was measured by tahoostcilografic method with monitors «Cardiocap» and «Dinamap-plus». The final analysis of the results carried out with the use of software for statistical studies of Excel.
Table 1. - The hemodynamic profile during laparoscopic (n1=48) and laparotomic cholecystectomies (n2=41)
Heart rate Мин-1 Systolic blood pressure, mmHg. diastolic blood pressure mmHg arterial pressure average mmHg. cardiac index l/minute-m 2 heart stroke index мл/м 2 total peripheral vascular resistance, Дин-с/ см 5-м 2 left ventricular filling pressure, mmHg
Before surgery 1 79,7±1,8 135,1±2,6 80,4±1,8 106,3±2,1 2,89±0,07 40,3±1,4 2707±36 11,4±0,4
2 76,4±2,3 139,4±2,2 82,7±2,3 109,2±2,2 2,90±0,06 38,5±1,5 2666±41 12,0±0,4
After pneumoperitoneum 1 92,1±2,7* 147,7±2,7* 88,2±3,1* 114,7±1,9* 2,69±0,08* 31,3±1,9* 3201±31* 9,5±0,4*
After laparotomy 2 85,6±3 138,3±3,1 79,4±2,7 103,3±2 2,88±0,07 36,8±1,8 2791±39* 11,3±0,33
Before liquidation Pnevmperitoneum. 1 87,0±2,8* 149,6±4,5* 92,1±3,9* 117,7±3,0* 2,45±0,10* 27,3±1,8* 3287±47* 8,3±0,39*
Before sutures 2 77,9±3,3 130,5±3,9 74,7±4,3 95,2±3,5 2,97±0,09 38,9±1,6 2241±39* 12,1±0,31
After the operation 1 82,5±3 141,4±3,6 82,8±2,9 113,4±2,5 2,91±0,08 38,1±2,1 2801±51* 10,6±0,37
2 78,9±3,1 140,4±2,9 84,5±2,7 106,1±2,8 2,79±0,12 36,5±1,7 2710±4 11,3±0,3
Note: * — the differences regarding the indicators of group 1 are significant (* — P <0,05)
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The study of the results of endolumbal insufflation of ozone and pyracetam in the treatment of posttraumatic epilepsy
In the case of patients operated laparoscopically increase of IAP, fixed with manometer of endoscopic equipment, was equal to 11,8 ± 0,16 mm Hg. The latter is interpreted as II Grade of IAP. The duration of the acute increase IAP due to pneumoperitoneum, was 52 ± 7 min. Changes in hemodynamic parameters associated with the rise of IAP during laparoscopic cholecystectomy, are presented in Table 1. Filling the abdomen with gas and, as a consequence, increase of IAP led to a decrease in cardiac index, left ventricular filling pressure and stroke index in the background of increase of total peripheral vascular resistance. Changing parameters in blood pressure are also characterized by a tendency to increase. The measurement results in patients operated laparoscopically were significantly different from the control parameters and from baseline (P <0.05).
After removing the pneumoperitoneum, as shown from Table 1, the hemodynamic profile was similar to the pre-operative. In the group of patients operated laparoscopically, remained significantly higher total peripheral vascular resistance. The other parameters of
blood circulation in patients after abdominal decompression were not significantly different from either preoperative values, or values from those in the comparison group. Changes in hemodynamic profile in a group of patients operated with laparotomic method, were less pronounced. Besides IAP the differences between the groups of patients who underwent cholecystectomy, concerned at the degree of traumatization forward abdominal wall. Laparotomy in this regard seems to be more traumatic than to puncture of the abdominal wall by trocar. However significant (for t-test) hemodynamic responses, as shown, is paired with acute IAP (pneumoperitoneum) and a rapid decline of IAP at the end of operation (elimination of pneumoperitoneum).
Conclusion. Thus, the imposition of pneumoperitoneum, or caused by this sharp increase in IAP, leading to the hypodynamic response of circulatory (decrease in SI and MI), with increased systemic vascular resistance, blood pressure, heart rate, decrease in left ventricular filling pressure. Removing of pneumoperitoneum led to the reversible changes.
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2. Acta Clinica Belgica: proceedings of the Third World Congress of the Abdominal Compartment Syndrome. - Antwerp, Belgium, 2007. - 21-24 March. - P. 113-118.
3. Akopyan R.V., Shahinyan A., Panoyan A. Prognostic Profile of Intra-Abdominal Pressure in SICU Patients//Anesthesiology. - 2013. -Р 2013. A1250.
4. Alsous F., Khamiees M., DeGirolamo A. Negative fluid balance predicts survival in patients with septic shock//Chest - 2000. - Vol. 117. - P. 1749-1754.
5. Baiter, D. E. Vacuum pack technique of temporary abdominal closure: a 7-year experience with 112 patients/D. E. Baiter, HJ. Kaufman, Smith L.A., Ciraulo D. L., Richart C. L., Bums R. P.//J Trauma. 2000. - № 48. - P. 201-206.
6. Balogh Z., Jones F., D'Amours S., Parr M., Sugrue M. Continuous intra-abdominal pressure measurement technique//Am J Surg. -2014. - Vol. 188. - P. 679-684.
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Aliev Mansur Abdukholikovich, Samarkand State Medical Institute, Senior researcher, Department of Neurosurgery, E-mail: dr.mansoor1982@mail.ru Mamadaliev Abdurakhmon Mamatkulovich, Samarkand State Medical Institute, Doctor of Medical Sciences, Professor, Department of Neurosurgery,
E-mail: mam412000@mail.ru Mamadalieva Saodat Abdurakhmonovna, Samarkand State Medical Institute, Neurosurgeon, Clinic of Neurosurgery, E-mail: saodat973@gmail.com
The study of the results of endolumbal insufflation of ozone and pyracetam in the treatment of posttraumatic epilepsy
Abstract: The article about use and the results of endolumbally insufflation of ozone and pyracetam in the treatment of posttraumatic epilepsy. Received the positive results — improved clinical and neurological status, reduced epileptic seizures. Keywords: endolumbally, ozone, pyracetam, posttraumatic, epilepsy.
Year after year due to the modernization of industry and transportation, increase of urbanization the level of traumatism, especially neuro-traumatism has become significantly high. As the result of craniocerebral traumas (CCT) in 45-60% of patients it has been
developed different types of invalid groups, partial and full limitations of working activities [1; 8; 9; 10; 13; 15]. CCT is the actual problem of Public Health and Health Policy and it is presented by the following conditions: 1). CCT mostly occurs in physically active
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