Method of monitoring violations of hepatic blood flow during surgical and postoperative periods hepatectomy

 

The invention relates to medicine, and is intended for monitoring violations of hepatic blood flow during surgical and postoperative periods hepatectomy. Injected dye reverdin in the bloodstream. Determine the total blood flow of the liver. Additionally set Winternitz catheter-meter through the umbilical duct in the portal vein and the method of local thermodilution determine the value of the portal and arterial blood flow. The measurements are carried out periodically 35-40 min during surgery and once daily in the postoperative period within 3-5 days. Decreasing these values in relation to the norms of hepatic blood flow is considered broken. The claimed method can prevent complications associated with circulatory disorders of the liver. 3 Il.

The invention relates to the field of medicine, anesthesiology, particularly to a method of monitoring violations of hepatic blood flow during surgical and postoperative periods when surgical resection of the liver.

The closest in technical essence to the present invention is a method for correcting violations of pécs is hewerdine into a peripheral vein at a rate of 0.5 mg/kg [4]. Blood sampling for studies produce 3 and 7 minutes. Serum photometrate on the spectrophotometer at a wavelength of 810 nm. The half-life of absorption hewerdine determined by the formula

,

where T/2 is the half-life of absorption hewerdine;

t - the difference in time between the sampling of blood;

lgExt3 is the logarithm of the first extinction;

IgExt7 is the logarithm of the second extinction.

Total liver blood flow is determined by the formula

,

and in identifying the violation assign appropriate therapeutic measures.

However, in the presented method does not stipulate a specific time criteria frequency of repeated studies of liver blood flow during surgery and in the postoperative periods, also the drawback is the lack of informative way due to the impossibility of using this correction method to calculate the arterial and portal fraction of total liver blood flow and limited scope due to the inability to control the system pressure of the portal vein, which in turn eliminates the possibility of timely correction of hemodynamic disorders introduction of drugs directly to to the boomershine liver, achieve application of a new method of monitoring violations of hepatic blood flow during surgical and postoperative periods hepatectomy, including the introduction of dye hewerdine in the bloodstream and the subsequent determination of the volume of total blood flow of the liver, and additionally establish Winternitz catheter-meter through the umbilical duct in the portal vein and the method of local thermodilution determine the size of the portal and arterial blood flow, and the measurements are carried out periodically 35-40 min run-time of surgery and once daily in the postoperative period within 3-5 days and decreasing these values in relation to the norms of hepatic blood flow is considered broken.

In Fig.1 shows Winternitz catheter-meter 6 with the outlet 11, a sensor 12 and the connectors 5 and socket 7 for connection to a recording device 3. In Fig.2 shows a schematic diagram of a device for calibration of the sensor-probe - catheter-meter 6, where 1 is the pressure sensor, 2 - vial with saline, 3 - recording device, 4 - syringe for the introduction of chilled saline, 6 - catheter-meter, 7 - equipped steketee fluid. In Fig.3 shows a connection diagram of a system for monitoring the state of blood flow in the vascular bed of the liver, which in addition to the pressure sensor 1, the vial with sterile saline 2 and catheter-measuring device 6 includes a sensor for ECG 8.

The method is as follows: the patient in the operating room before surgical intervention under local infiltration anesthesia or intravenous anesthesia through a small incision of the anterior abdominal wall 2 cm above the navel allocate umbilical duct. Sequential introduction of bugei diameter from 3 to 5 mm provide cross obliterating plots umbilical duct. Then injected into the portal vein Winternitz catheter-meter 6 (Fig.1, 2). The distance between the outlet opening of the channel for the introduction of indicator solution (solution of sodium chloride 0.9 per cent to 20 ml, the temperature of 18C) to the probe 11, which is located at the distal end of the catheter is 8 cm, due to the length of the portal vein from 10 to 12 see the catheter is modified analogue of the catheter Swan-Ganza shortened to 8 cm (Fig.1) the distance between the outlet opening of the channel for the introduction of indicator solution and t consisting of thermostat 9, closed system, including a system of silicone tubing 13 with a diameter of 10 mm, which circulates heated to 37 Withsaline in a volume of 2000 ml with predetermined velocity from 100 to 2000 ml/min electrical impulse arising in response to the introduction of indicator solution (20 ml of physiological solution was cooled to 18C), written in the form of the curve of the recorder polygraph-34” (Fig.2, 3). Area curves termorshuizen estimated using a developed computer program in accordance with the set speed of the minute liquid circulation in the calibration device.

After installation of catheter-meter in patient portal vein in the cubital vein bolus injected reverdin at a dose of 0.5 mg/kg of blood Sampling for the study was made on the 3rd and the 7th minute. Serum was photometrically on the spectrophotometer at a wavelength of 810 nm. The half-life of absorption hewerdine determined by the formula

,

where T/2 is the half-life of absorption hewerdine, the difference in time between the sampling of blood;

lgExt3 is the logarithm of the first extinction;

lgExt7 is the logarithm of the second extinction.

Total liver blood flow is determined by Faure

In the same period, conduct a three-to fourfold study of blood flow velocity in the portal vein and according to the usual method calculates the value of the blood flow in the portal vein at each stage of the research. At a known value of the total liver blood flow and blood flow in the portal vein easily calculate the arterial fraction of the total blood flow of the liver. Measurement of pressure in the portal vein carried out continuously. Monitoring blood flow and pressure in the portal vein is carried out in the immediate postoperative period daily once a day for 3-5 days depending on the severity of the patient. In the case of pathological changes of the values of hemodynamic parameters in the system of the portal vein carry out rapid medical correction through the administration of drugs directly into the bloodstream to the liver via installed in the portal vein catheter.

During normal functional state of the liver half-life of excretion of hewerdine 2-3 minutes After complete resection of liver duration of this indicator increased to 16-18 minutes When interpreting obtained in the analysis of clinical observations for this category of patients the optimal interval for op the postoperative period once a day for 3-5 days, that allows to obtain reliable data on the dynamics of changes in the hemodynamics of the liver during the main stages of the operational period hepatectomy, such as the beginning of the operation, after performing liver resection and after surgical intervention in the postoperative period. Knowledge of the parameters of vascular homeostasis of the liver obtained periodically during surgical manipulation of the body, allows timely corrective therapy to reduce negative impacts on unaffected parts of the liver tissue and prevent the development of postoperative liver failure.

The simultaneous study of total liver blood flow and blood flow in the portal vein were performed in 40 patients undergoing surgery on the liver. The results of the research provided the opportunity for an objective analysis of the state of hepatic hemodynamics depending on the methods of General anesthesia and trauma surgery. These studies allowed us to assess the effect of General anaesthesia on the blood circulation of the liver, which helped to develop the optimal method of anesthesia during operations rescue the load on the liver cells.

Great influence on the recovery of the functional state of the liver in the postoperative period is the normalization of hemodynamic parameters in the system of the portal vein. Given that the blood supply to the liver by 2/3 at the expense of blood flow in the portal vein, the measurement of its magnitude can be made as often as necessary. Due to the significant reduction in the area of perfusion surface remaining after the operation of unaffected areas in the liver there is a significant increase in pressure in the portal vein, accompanied by a decrease of blood flow velocity. Untimely correction of such complications leads to accumulation in the vascular pool portal vein large amounts of sedentary extracellularly liquid with a simultaneous decrease in the number of functionally active extracellular extravascular fluid, which plays a major role in the stability of hemodynamic parameters. Introduction through the catheter in the portal vein of the necessary drugs can prevent the development of asthma such complications and improve the quality of surgical treatment of patients with liver disease. Due atomnoy vein (using umbilical duct for kanalirovaniya the portal vein caused by availability, the simplicity of technical performance and safety for the patient), as well as the simultaneous execution weerdinge test, i.e. it allows along with figures obtained during its implementation, such as the amount of hepatic blood flow and absorption-excretory function of the liver, in the same conditions to obtain other as the values of portal and arterial blood flow and pressure in the portal vein, which improves the accuracy, informativeness and efficiency of the method, and also increases the effectiveness of remedial measures at the expense of a more adequate choice and speed of their conduct (directly into the bloodstream to the liver via the portal vein).

Clinical use of this method of correction of disorders of the hepatic blood flow during surgical and postoperative periods when operations liver resection is illustrated by the following example.

Example 1. Patient P., 25 years old, medical history, No. 3368, diagnosis - alveococcosis right lobe of the liver, operated 20 June 1989. The operation right hemihepatectomy. Before surgery signs of liver dysfunction was not. The total blood flow of the liver prior to surgery, a specific method of cultivation of hewerdine, status is current liver thus amounted to 296 ml/min The system pressure of the portal vein was 17 mm RT.article (slightly exceeded the normal value). After the execution phase of the operation liver resection had a significant decrease in the blood flow of the liver. Index of total liver blood flow decreased to 337 ml/min, while the flow in the portal vein decreased to 198 ml/min, the rate of arterial blood flow decreased to 139 ml/min After the end of the operation the total liver blood flow was increased to 435 ml/min due to increase arterial blood flow to 248 ml/min While the flow in the portal vein remained at a low level and was in this period of 178 ml/min. Pressure in the portal vein increased to 23 mm RT.article Postoperative monitoring of blood flow velocity and pressure in the portal vein with the active introduction into the bloodstream of the portal vein medicines, improving microcirculation, continued. Medicinal environment was balanced composition of colloid and crystalloid solutions, as well as drugs that reduce the resistance of the intrahepatic vascular systems. On the third day of the postoperative period the blood flow in the portal vein was almost restored to its original value and sleepy and continuous process, which are formed sufficiently effective compensatory mechanisms to maintain adequate blood supply to the liver. However, conducting drug therapy directly into the bloodstream to the liver contributes significantly to a more rapid recovery (within three days) hepatic blood flow.

Example 2. Patient Z., 58 years old, medical history, No. 1953, diagnosis - cancer of the right lobe of the liver, operated 12 April 1989. The operation - extended right hemihepatectomy. The tumor up to 10 cm in diameter is front and Central parts of the right lobe of the liver and squeezes the gate of the liver. Due to the prevalence of significant circulatory liver prior to surgery, which is reflected in the indicator of total liver blood flow, the value of which amounted to 443 ml/min While the amount of blood flow in the system of the portal vein was 174 ml/min, which is explained by the development of portal hypertension due to compression of the portal vein is the main process. After performing hemihepatectomy values of hepatic blood flow decreased to a critical level. Total liver blood flow during this period amounted to 225 ml/min After the end of operatioal blood flow in the portal vein decreased to 159 ml/min, the pressure increased to 27 mm RT.article To improve blood circulation in the basin of the portal vein through a catheter inserted through the umbilical duct in the portal vein, carried out intensive infusion and drug therapy, including drugs, improves blood rheology, and increase the resistance of the vascular wall of the blood channel of the portal vein (solution of oxytocin). On the fifth day of the postoperative period, blood flow of the portal vein was 231 ml/min, the pressure was reduced to 17 mm RT.article.

Thus, clinical application of the method of correction of disorders of hepatic blood flow during surgical and postoperative periods when operations liver resection is justified and in most cases necessary for the surgical treatment of pathological processes in the liver. The method is characterized by simplicity and security, high efficiency, no negative effects on the energy potential of the damaged liver, the ability to provide constant monitoring of the dynamics of changes of blood circulation indices in the system of the portal vein during surgical and polyopia is dinamiki. Provides direct administration of drugs in the bloodstream to the liver and determines the timing of remedial measures to correct the violations in microcirculatory vascular space after surgical manipulation of the body. The method does not require expensive equipment and can widely be used in practical health network.

Bibliography

1. Danilenko, M. C., Kossak B. I. - Methodology aimed catheterization of the hepatic veins - nursing, 1972, No. 5, S. 21-23.

2. Yevtushenko A. L. - Method local thermodilution for measurement of portal and hepatic blood flow - summary on saisc. academic Art. Dr. med. Sciences, 1973.

3. Cyberne K. A., Boers N. E. - Ofeveryday research method hepatic blood flow - Exp. surgery and anesthesiology, 1975, S. 81-84. The prototype.

4. Revneue So, the Study of liver blood flow using ultrasound abnormal Doppler waveforms, 2002 - www.hepatic.ru/hi0500/1

Claims

Method of monitoring violations of hepatic blood flow during surgical and postoperative periods hepatectomy, including the introduction of dye hewerdine in the bloodstream and the pic is wherevery catheter-meter through the umbilical duct in the portal vein and the method of local thermodilution determine the value of the portal and arterial blood flow, moreover, the measurements are carried out periodically 35-40 min run-time of surgery and once daily in the postoperative period within 3-5 days and decreasing these values in relation to the norms of hepatic blood flow is considered broken.

 

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