ASSESSMENT OF THE LEVEL OF ACID-BASE STATUS IN THE CONDITIONS OF CHRONIC ARTERIAL ISCHEMIA DURING RECONSTRUCTIVE SURGICAL INTERVENTIONS

Abstract

The aim of the work: to study the indicators of acid-base status (ABS) in patients with stenotic-occlusive atherosclerotic process of the infrainguinal bed with and without concomitant diabetes mellitus (DM) in the conditions of reconstructive interventions.

Materials and Мethods. An analysis of the examination and surgical treatment of 241 patients was conducted. Patients were divided into 2 groups. The first group (Group I) included 144 (59.7 %) patients with atherosclerotic stenotic-occlusive process of the infrainguinal segment, the second group (Group II) included 97 (40.2 %) with atherosclerotic stent-occlusive process of the infrainguinal segment with concomitant type 2 diabetes mellitus (DM). According to the types of surgical interventions performed (endovascular and hybrid), patients from each group were divided into two subgroups: A and B. The IA subgroup included 98 (40.6 %) patients with atherosclerotic stenotic-occlusive process of the infrainguinal segment who underwent endovascular revascularization, and the IB subgroup included 46 (19.0 %) patients who underwent hybrid methods of intervention. The IIA subgroup consisted of 63 (26.1 %) patients with atherosclerosis of the infrainguinal segment and concomitant type 2 diabetes mellitus, who underwent endovascular operations, and the IIB subgroup consisted of 34 (14.1 %) patients who underwent hybrid interventions.

Results. Determination of ABS indicators was carried out at several stages of the study. In patients from the IA subgroup, a decrease in the level of hydrogen indicator (pH) was observed before surgery and in the intraoperative period by 0.4 and 1.1 %, respectively. The pH factor in the IB subgroup was lower than normal (1.1 %) at the preoperative stage and by 1.9 % in the intraoperative period. The content of bicarbonates (HCO₃^–), base excess (BE^–) and Cl^– was reduced, and lactate was increased before treatment. The concentration of hydrogen ions in individuals from the IIA subgroup was below the normal range by 2.7 % before the operation, which was influenced by a decrease in the partial pressure of oxygen (pO₂), HCO₃^–, BE^– and an increase in the levels of the partial pressure of carbon dioxide (pCO₂), lactate, and ketone bodies. The content of ketone bodies in patients from the IIA subgroup before revascularization exceeded the norm by 33.3 %. The pH level in individuals from the IIB subgroup before surgery was 7.04, and exceeded the norm by 4.2 %. After correction of these violations at the intraoperative stage, in the early and late postoperative periods, the pH indicator was within the normal range. The shift of metabolic indicators HCO₃^–, BE^– occurred in the downward direction, and the levels of pCO₂, Na⁺, K⁺, Cl^–, lactate, and ketone bodies increased.

Conclusions. In conditions of chronic arterial ischemia of the lower extremities, violations of the ABS occur, the most important of which are metabolic acidosis, hyperkalemia and changes in the level of pCO₂. Restoration of blood flow is an important stage for the normalization of ABS and improvement of metabolism in tissues.