Title (srp)

Prognostička vrednost saturacije centralne venske krvi kiseonikom i nivoa laktata u serumu nakon rekonstruktivnih operacija na abdominalnoj aorti: doktorska disertacija

Author

Šoškić, Ljiljana Ž., 1958-

Contributor

Palibrk, Ivan
Stanković, Goran, 1962-
Lađević, Nebojša
Milaković, Branko, 1956-
Miličić, Biljana, 1967-

Description (eng)

For evaluation of global tissue hypoperfusion routinely is used mixed venous oxygen saturation Sv̄ O2 and lactate level. Lactate is a delayed parameter of tissue hypoperfusion because of complex lactate kinetics, while half-life of oxygen saturation is measured in seconds, so that it is an early indicator of organ hypoperfusion. We evaluated the relationship between central venous oxygen saturation ScvO2 and Sv̄ O2 in elective surgery of the abdominal aortic aneurysm (AAA). The adequacy of their interchangeability was tested by comparing cardiac indices (CI) calculated by two methods in patients that underwent abdominal aortic surgery. The concept of utilizing ScvO2 instead Sv̄ O2 is again active, because that the ScvO2 is parameter obtained by taking blood samples from CVC. That catheter is cheaper, the majority of doctors are skillful by its placement, and its placement is followed up with a lower risk. OBJECTIVE: Principle objective of our study was to test the correlation between ScvO2 and Sv̄ O2 in different time frames, in patients undergoing elective AAA surgery. Additionally, we wanted to determine if the use of ScvO2 for calculating CI, by modified Fick equation (CI-F), could be feasible and accurate surrogate for the values obtained by PAC. We also examined the influence of ScvO2 and lactate level, measured in successive time intervals, on the outcome of treatment. METHODS: Prospective observational study included 125 consecutive patients that underwent elective AAA surgery. The ScvO2 and Sv̄ O2 data, as well as CI and CI-F values, were obtained and compared from samples taken in three different time frames: immediately after induction of general anesthesia (T0), immediately after admission in the intensive care unit (ICU)(T1), and 8h after admission in the ICU (T2). Fick equation, used for CI estimation from ScvO2 (CI-F), for the purpose of this study, was simplified according to Walley. At the same time , we measured the level of serum lactate. RESULTS: There was good linear correlation between ScvO2 and Sv̄ O2 in all time frames and linear regression study revealed strongest coefficient of determination (R2=0.661) in T2 time-frame. There was no correlation between CI-F (i.e. CI calculated from ScvO2 by modified Fick equation) and CI (measured by PAC fromSv̄ O2 ) in any time-frame. Data were tested using the Pearson,s coefficient of correlation...

Description (srp)

Za procenu stanja mikrocirkulacije i perfuzije tkiva i organa standardno se koriste saturacija mešane venske krvi kiseonikom (Sv̄ O2) i nivo serumskog laktata. Laktat je odloženi pokazatelj tkivne hipoperfuzije jer podleže složenom metabolizmu, dok se poluživot saturacije venske krvi kiseonikom meri u sekundama te je ona rani pokazatelj hipoperfuzije organa. Ispitivali smo korelaciju između vrednosti saturacija kiseonikom krvi iz centralne vene (ScvO2) i plućne arterije (Sv̄ O2) tokom operativnog i ranog post operativnog perioda. Odnos između ova dva parametra testirali smo upoređivanjem vrednosti srčanog indeksa (CI) izračunatih na dva načina, kod elektivno operisanih bolesnika zbog aneurizme abdominalne aorte (AAA). Koncept korišćenja ScvO2 umesto Sv̄O2, za izračunjavanje CI ostaje kontroverzan s obzirom da još uvek nema pouzdanih podataka koji bi ukazivali da jedna saturacija može biti adekvatna zamena drugoj. ScvO2 parametar koji se dobija uzimanjem uzoraka krvi iz centralnog venskog katetera (CVC), a Sv̄ O2 uzimanjem uzoraka krvi iz plućnog katetera (PAC). Upotreba ScvO2 umesto Sv̄ O2 za procenu tkivne hipoperfuzije je aktuelna metoda s obzirom da je CVC znatno jeftiniji i tehnički lakši za korišćenje od PAC-a što umanje rizik od nastanka komplikacija. CILJ: Svrha studije je testiranje korelacije između ScvO2 i Sv̄ O2 u različitim vremenima merenja kod pacijenata podvrgnutih elektivnim operacijama AAA. Dodatno smo želeli da ispitamo da li izračunati CI korišćenjem ScvO2 pomoću Fick-ove jednačini (CI-F) može biti adekvatna zamena CI dobijenom merenjem putem PAC-a. Takođe, ispitivali smo uticaj ScvO2 i nivoa laktata u serumu, merenih u sukcesivnim vremenskim intervalima, na ishod lečenja. METOD: Prospektivnom observacionom studijom obuhvatili smo 125 konsekutivnih bolesnika podvrgnutih elektivnim operacijama na abdominalnoj aorti usled anaeurizmatske bolesti.Vrednosti ScvO2 i Sv̄ O2 kao i CI su dobijene uzimanjem uzoraka krvi i merenjem u tri različita vremena. Nakon uvoda u opštu anesteziju (T0), nakon dolaska u JIL (T1), i 8h nakon dolaska u JIL (T2). U svrhu ove studije koristili smo uprošćenu Fick-ovu jednačinu po Walley za izračunavanje CI-F iz ScvO2. U istim vremenima merenja određivali smo i nivo serumskog laktata...

Description (srp)

Medicina - Anesteziologija sa reanimatologijom / Medicine- Anesthesiology with Resuscitation Datum odbrane: 27.09.2018.

Object languages

Serbian

Date

2018

Rights

Creative Commons License
This work is licensed under a
CC BY 2.0 AT - Creative Commons Attribution 2.0 Austria License.

CC BY 2.0 AT

http://creativecommons.org/licenses/by/2.0/at/

Subject

Venous oxygen saturation, Cardiac index, Serum lactate, Tissuehypoperfusion

OSNO - Opšta sistematizacija nau?nih oblasti -- Medicina (29) -- Hirurgija (2942) -- Anesteziologija (294200)

Identifiers