Obstetric blood loss: priorities in the infusion solutions choice
Objective. To study the effect of Rheosorbilact on the main life support systems in patients with massive blood loss in obstetrics.
Materials and methods. The study was carried out in 56 puerperas with massive blood loss during obstetric operations for placenta previa. Surgical intervention was performed under general multicomponent anesthesia with mechanical ventilation. After the end of the operation, the patients were on prolonged mechanical ventilation for 4-6 h until the main life support systems were stabilized. With the purpose of infusion therapy were used Rheosorbilact (13-15 ml/kg), 0.9 % sodium chloride solution (25-30 ml/kg) and blood components. The main life support systems were assessed by non-invasive monitoring of central and peripheral hemodynamics and autonomic nervous system.
Results and discussion. Blood loss was 1500-2000 ml, which developed within 20 min from the moment of the start of the operation. Taking into account the pharmacological properties of the drugs used, infusion therapy began with a jet intravenous injection of Rheosorbilact followed by the introduction of 0.9 % sodium chloride. After 30 min from the onset of bleeding and the administration of infusion-transfusion therapy, a significant increase in cardiac output over the initial parameters was noted. At the same time, the epicardial fat volume (EFV) significantly decreased by 4.4 %. 30 min after the end of the infusion-transfusion therapy, a stable hemodynamic profile was noted. 4 h after the end of the infusion therapy, there was an increase in cardiac output and MDP relative to the original value, a decrease in post-load and heart rate, an increase in EFV by 8.1 % (p<0.05). SI decreased by 54.6 % (p<0.05). Diuresis significantly increased to 1.75 ml/kg/h. The initial intravenous infusion was with Rheosorbilact. Considering that the transition of extracellular fluid into the vascular bed is a rather slow process, the transfusion of a hyperosmolar solution exceeding the plasma pressure is more justified. Within 30 min from the start of infusion therapy, the hemodynamic profile stabilized.
Conclusions. In acute massive blood loss, the use of Rheosorbilact allows you to quickly, effectively and safely correct the deficit in circulating blood volume. Primary targeted hemodynamic support with the use of a low-volume hyperosmolar infusion of Rheosorbilact makes it possible to achieve hemodynamic stabilization with a smaller infusion volume due to interstitial redistribution of fluid into the vascular bed.
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