Експериментальне обгрунтування розвитку некардіогенного набряку легень у хірургічних хворих при обмеженій руховій активності

Abstract

Ефективність оперативного лікування залежить не тільки від якості виконання предопера- ної підготовки і самого хірургічного втручання, але і від адекватного ведення послеопераці- ційного періоду. Серед ускладнень, які виникають в цей період, значний відсоток становить післяопераційна бронхолегочная патологія. Аналіз результатів експериментальних досліджень, присвячених вивченню впливу іммобілізації на легкі щури, дозволяє вважати післяопераційну стресову реакцію на тлі обмеженої рухової активності одним з факторів, що сприяють виникненню і розвитку післяопераційного некардіогенного набряку легенів. Эффективность оперативного лечения зависит не только от качества выполнения предопера- ционной подготовки и самого хирургического вмешательства, но и от адекватного ведения послеопераци- онного периода. Среди осложнений, которые возникают в этот период, значительный процент составляет послеоперационная бронхолегочная патология. Анализ результатов экспериментальных исследований, посвященных изучению влияния иммобилизации на легкие крысы, позволяет считать послеоперационную стрессовую реакцию на фоне ограниченной двигательной активности одним из факторов, способствующих возникновению и развитию послеоперационного некардиогенного отека легких. Nowadays, it is considered that the effectiveness of surgical treatment depends not only on the quality of preoperative preparation measures and the surgery itself, but also on adequate postoperative care. Its optimization is determined by the correct assessment of the course peculiarities, the prediction of possible complications and conducting preventive measures for their elimination in each individual case. In the postoperative period the patient is in a special condition caused by disease, surgical interference itself, influence of used drugs for anesthesia. In general, this condition should be considered as “post-surgical stress”, when recovery depends on the effectiveness of treatment and adaptive capacity of the patient’s organism. One of the most severe complications that can occur during surgery and in the postoperative period is a pulmonary edema. It is traditionally considered as pulmonary manifestation of heart insufficiency or consequence of hyperinfusion. However, the final genesis of postoperative pulmonary edema remains poorly examined. Nowadays, the majority of reanimatologists define that hemodynamic disorders in the early postoperative pulmonary edema occur in patients with concomitant toxic or metabolic myocardial injury, valvular heart disease and similar cases. Late postoperative pulmonary edema develops not only on the background of the hemodynamic disorders, which accompany other postoperative bronchopulmonary complications, but also can be a final stage of severe protein deficiency with extreme hypoproteinemia, infectious and inflammatory endotoxicosis, decompensation of concomitant hypertension and others. In our opinion, the experimental study performed at the Department of medicine of emergency situations with operative surgery and topographic anatomy of the Higher state educational establishment of Ukraine «Ukrainian medical stomatological academy» is interesting and reveals the morpho-functional changes in the lungs of white Vistar line rats which arise on the background of immobilization stress. The results of this research can explain some mechanisms of postoperative complications development of the respiratory system, in particular noncardiogenic pulmonary edema. Since a significant part of patients after surgery is on bed regime with limited physical activity, their condition can be compared with partial immobilization. This fact suggests that morpho-functional changes occurring in the body of such patients will be identical with the similar to experimental on the reconstruction immobilization stress models. Acute immobilization stress at the macroscopic level causes a distinct hemorrhagic changes, and on the microscopic level leads to significant dilation of the lungs alveoli, destruction and thinning of the interalveolar septa, thickening and destruction of the mucous membrane epithelium of the bronchi, disorders of microcirculation. Chronic immobilization macroscopically causes the emphysema phenomenon in the lungs, and at the microscopic level it leads to a significant dilation of the alveoli of the lungs, deformation and thinning of the interalveolar septa, thickening and destruction of the epithelial layer of the bronchi mucous membrane, disorders of hemomicrocirculation with hemorrhage symptoms in interstitial connective tissue. The results of this study allow us to consider postoperative stress reaction on the background