Improving microcirculation as a factor in the recovery of comorbid patients after surgical interventions

Abstract

Aim - to study the need to optimize microcirculatory perfusion according to the literature and our own experience in order to reduce postoperative complications and speed up the recovery of surgical patients.

Perioperative recovery in comorbid patients helps prevent complications after surgery, including reducing the risk of respiratory and cardiovascular complications. However, even after optimizing macrohemodynamic parameters, some patients develop microcirculatory dysfunction, which is associated with a higher incidence of postoperative complications. Surgical intervention is a regional trauma and also causes regional microcirculatory impairment. Elevated lactate levels and a high incidence of postoperative organ damage indicate that microcirculation may be impaired in surgical patients. Stress hyperglycemia has been identified as an independent risk factor for increased mortality Potentially adverse effects of hyperinsulinemia can be corrected by the administration of polyhydric alcohols (polyols), among which xylitol occupies an important place. Correction of iron deficiency in the intensive care unit with biomarker signs of tissue hypoxia (decreased hepcidin) leads to the restoration of microcirculation and improved survival of these patients. Hyperosmolar solutions contribute to fluid moderation of the flow of fluid from the intercellular space into the vascular bed, which leads to improved microcirculation and tissue perfusion, and also has a diuretic effect and the removal of excess fluid volume.

Conclusions. The ultimate goal of hemodynamic management is the optimization of microcirculatory perfusion. Considering the multifunctionality of Reosorbilact, namely the presence of hemodynamic action, pronounced detoxification effect, improvement of microcirculation and rheology, correcting water-salt and acid-base balance, it is recommended to use it as a balanced solution to improve microcirculation in various surgical pathologies. The iron saccharate preparation Sufer allows you to fill the iron depot as quickly as possible and significantly reduce the negative impact of hemic and hypoxic hypoxia, in particular on the microcirculatory bed, by improving tissue respiration and, as a result, improving microcirculation in the area of surgical intervention, which, in turn, is the key to wound healing per prima. The introduction of the drug Xylat to patients after non-cardiosurgical interventions leads to the correction of stress hyperglycemia, a decrease in the severity of postoperative asthenia and motivates patients to an early motor regimen.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The informed consent of the children's parents was obtained for the research.

No conflict of interests was declared by the authors.