SYSTEM OF ANAESTHETIC SUPPORT AT LARGE JOINT REPLACEMENT SURGERIES
Abstract and keywords
Abstract (English):
Vypolnenie operaciy total'nogo endoprotezirovaniya krupnyh sustavov sopryazheno s neskol'kimi anesteziologicheskimi problemami, reshenie kotoryh obespechivaet bezopasnost' vypolneniya etih vysokotravmatichnyh operaciy i trebuet resheniya sleduyuschih anesteziologicheskih zadach v perioperacionnom periode: vysokaya stepen' antinociceptivnoy zaschity pacientov s effektivnoy relaksaciey zony operativnogo vmeshatel'stva; profilaktika zhirovoy giperglobulemii; snizhenie ob'ema perioperacionnoy gemorragii i profilaktika trombogennyh oslozhneniy. Razrabotana sobstvennaya programma anesteziologicheskogo obespecheniya pri protezirovanii krupnyh sustavov, komponentami kotoroy yavlyayutsya: vid obezbolivaniya – subarahnoidal'naya anesteziya s sohranennym spontannym dyhaniem pacienta; sobstvennyy sposob profilaktiki zhirovoy globulemii, osnovannyy na sohranenii funkcional'noy stabil'nosti gepatocita; sobstvennyy sposob vospolneniya perioperacionnoy krovopoteri, osnovannyy na dopolnitel'nom principe «normalizaciya onkoticheskogo davleniya krovi». Do nachala operacii pacienty poluchayut rastvor traneksamovoy kisloty v doze 10 mg/kg massy dlya ingibirovaniya sobstvennogo proteoliza (tehnologiya krovosberezheniya). Etot priem obespechivaet «suhoe» operacionnoe pole, umen'shaya intraoperacionnuyu gemorragiyu. V rannem posleoperacionnom periode (cherez 5 chasov posle zaversheniya operacii) pod kontrolem vremeni svertyvaniya cel'noy krovi pacienty poluchayut nizkomolekulyarnyy geparin kleksan v lechebnoy dozirovke 1 mg/kg massy. Eto obespechivaet effektivnuyu profilaktiku trombogennyh oslozhneniy. Primenenie razrabotannoy metodiki pokazyvaet ee vysokuyu klinicheskuyu effektivnost'. Za poslednie 5 let vypolneno 5800 operaciy po protezirovaniyu krupnyh sustavov, v tom chisle 3200 operaciy total'nogo endoprotezirovaniya tazobedrennogo sustava (TETS), 2600 operaciy total'nogo endoprotezirovaniya kolennogo sustava (TEKS). Oslozhneniy s letal'nym ishodom ne bylo, v 5 sluchayah byla otmechena zhirovaya giperglobulemiya, kotoraya kupirovana sobstvennym sposobom lecheniya. Trombogennyh oslozhneniy ne zaregistrirovano.

Keywords:
endoprotezirovanie krupnyh sustavov, sistema anesteziologicheskogo obespecheniya, subarahnoidal'naya anesteziya, zhirovaya globulemiya, trombogennye oslozhneniya
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References

1. Sistema anesteziologicheskogo obespecheniya

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