Correction of the acid-base balance of the blood in the system of prevention and treatment of reperfusion-reoxygenation syndrome in patients with chronic critical ischemia of the lower extremities

Authors

  • I. K. Venher I. Horbachevsky Ternopil National Medical University
  • N. I. Herasymiuk I. Horbachevsky Ternopil National Medical University
  • S. Ya. Kostiv I. Horbachevsky Ternopil National Medical University
  • A. R. Vayda I. Horbachevsky Ternopil National Medical University
  • M. O. Husak I. Horbachevsky Ternopil National Medical University

DOI:

https://doi.org/10.11603/2414-4533.2020.2.10759

Keywords:

ischemia, acidosis, reperfusion, atherosclerosis

Abstract

The aim of the work: improving the effectiveness of the system of prevention and treatment of reperfusion-reoxygenation syndrome (RRS) in patients with chronic critical lower limb ischemia by introducing an acid-base balance correction.

Materials and Methods. Studies were conducted in 79 patients with atherosclerotic lesions of the aortoiliac-femoral segment. In 52 cases, aorto-bifemoral alloshunting were performed, in 17 of them femoral-distal autoveneous bypass was performed simultaneously. 27 patients underwent unilateral aortoiliac-femoral alloshunting, and in 6 of them simultaneously performed femoral-distal auto­genous bypass grafting. Surgical treatment of patients (19 observations) with a high risk of developing RRS in the early postoperative period was performed after special systematic training, whose main purpose was prevention and treatment of RRS. 30 patients with a high risk of developing reperfusion-reoxygenation syndrome RRS were also operated on after a special system of training, which was supplemented with aids to correct the acid-base balance of blood (Trometamol). The control group consisted of 22 individuals, without manifestations of atherosclerotic lesions of the arterial bed of the lower extremities. For the study, blood sampling from the subcutaneous vein of the posterior ischemic lower extremity was performed before surgery, at 1, 3, and 5 days postoperatively.

Results and Discussion. In the analysis of blood parameters of acid-base balance (ABB) from the subcutaneous vein of ischemic lower extre­mities in patients with atherosclerotic lesions of the aortoiliac-femoral segment, its displacement toward metabolic acidosis was established.

The most significant changes in ABB were observed in patients with stage II-IV chronic arterial insufficiency (ChAI). The pH of venous blood of the ischemic lower extremity in patients with this stage of ChAI is within the decompensation of metabolic acidosis.

In patients with stage IІIB-IV of ChAI and at risk of developing reperfusion-reoxygenation syndrome RRS, reconstruction of the aortoiliac-femoral segment was performed after systematic preparation for the prevention and treatment of RRS without correction of ABB. The results of the study of ABB in the first day of the early postoperative period indicated a deepening of decompensated acidosis.

Revascularization of the arterial bed in patients with stage IIB-IV of ChAi did not significantly contribute to the reduction of the level of ABB. And already on the 5th day of the postoperative period, on the background of the medical correction, the ABB level reached the values ​​of the control group.

References

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Published

2020-01-20

How to Cite

Venher, I. K., Herasymiuk, N. I., Kostiv, S. Y., Vayda, A. R., & Husak, M. O. (2020). Correction of the acid-base balance of the blood in the system of prevention and treatment of reperfusion-reoxygenation syndrome in patients with chronic critical ischemia of the lower extremities. Hospital Surgery. Journal Named by L.Ya. Kovalchuk, (2), 21–26. https://doi.org/10.11603/2414-4533.2020.2.10759

Issue

No. 2 (2020)

Section

ORIGINAL INVESTIGATIONS

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