ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 22 of 60
УЖМБС 2019, 4(6): 157–165
Clinical Medicine

Risks of the Postoperative Acute Kidney Injury Development in Different Regimes of Infusion Therapy in Moderate and High Surgical Risk Patients with Acute Abdominal Pathology

Kravets O. V.

Urgent surgical intervention is accompanied by significant numbers of mortality that depends on the frequency and severity of postoperative complications. One of the most common postoperative adverse events is acute kidney injury. The purpose of the study was to conduct a comparative analysis of the relationship between the frequency of postoperative acute kidney injury, degree of surgical risk and the development of interstitial edema in different modes of infusion therapy in patients with intermediate and high surgical risk with acute abdominal pathology. Material and methods. The prospective observational study lasted from January 2016 to December 2018 after approval by the Ethical Commission of the State Institution “Dnipro Medical Academy” of the Ministry of Health of Ukraine. We examined 160 patients with acute abdominal pathology with the degree of volume depletion of more than 10 % and less than 30 %. The patients were operated urgently. The indices of urine output and the need for pharmacological stimulation of diuresis were investigated. The laboratory checked the level of serum creatinine, urea, urea nitrogen, and calculated creatinine clearance during 10 days of the postoperative period. The extra–, intracellular and intravascular water parameters were determined by the technique for noninvasive bioelectrical monitoring rheography complex KM–AR–01 "Diamond" V11.0 and used to calculate the volume of the interstitial space. Results and discussion. The 1st stage of acute kidney injury was determined in the restrictive regime of infusion therapy in moderate surgical risk patients during the first day of perioperative period. In high surgical risk patients it was detected during goal–direct infusion therapy. The 1st stage of acute kidney injury was determined in liberal regime group during seven days after surgery. Conclusion. In group of moderate surgical risk patients the liberal regime was accompanied by the development of interstitial edema, decreased filtration of kidneys and the development of postoperative renal damage of the first level from 1 to 7 days after surgery. The restrictive regime for moderate surgical risk patients kept the volume of interstices within the boundaries of the rules during all the postoperative period and was accompanied by the threat of the 1st degree of acute kidney injury development in the first day. In patients with high surgical risk, goal–directed mode increased interstitial volume and was accompanied by the threat of the 1st degree of acute kidney injury development in the first day. Restrictive regime limited the development of interstitial edema and provided safe perioperative period.

Keywords: emergency laparotomy, acute kidney injury, interstitial edema, surgical risk, infusion therapy

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