Year 2016 Vol. 24 No 6

GENERAL & SPECIAL SURGERY

A.V. STAKANOV 1, 2,3, S.P. DASHEVSKII 1,2, T.S. MUSAYEVA 3, E.A. POTSELUEV 4, I.B. ZABOLOTSKIKH 3

RISK OF ACUTE KIDNEY INJURY DEVELOPMENT IN ACUTE COLONIC OBSTRUCTION

SBE RR "Rostov Regional Clinical Hospital" 1,
SBEE HPE "Rostov State Medical University" 2,
SBEE HPE "Kuban State Medical University" 3, Krasnodar,
MBME "City Hospital 7 of Rostov-on Don" 4,
Rostov-on Don ,
The Russian Federation

Objectives. To assess the risk of acute kidney injury (AKI) in patients with acute colonic obstruction (ACO), depending on the extent of intra-abdominal hypertension (IAH).
Methods. Clinical observations included patients with ACO (n=220). Four groups according to the initial grade of the AHI were identified, which was estimated on the basis of urinary bladder pressure: 1 0 grade IAH 0-11 mmHg (n = 64); 2 1 grade IAH 12-15 mmHg (n = 54); 3 2 grade IAH 16-20 mmHg (n = 78); 4 3 grade IAH 21-25 mmHg (n = 18); 4 grade IAH> 25 mmHg was not revealed. AKI was diagnosed when at least one of the criteria (KDIGO) was present. Stroke Index (SI, mL/m2) was determined hourly by the transmission time of the pulse wave (esCCO technology, Nihon Kohden). The criteria for the daily comparison in groups were the following: prevalent type of circulation, volemic and oxygen status, diuresis, blood biochemistry parameters.
Results. Hypovolemia was confirmed by low or borderline levels of a central venous pressure (CVP) in all four groups, the severity degree of volemic disorders is inversely proportional to the level of intra-abdominal pressure. Infusion in the 4th group was limited to a decreased myocardial contractility according to the results of increments in central venous pressure (CVP); hemodynamic profile had an initial tendency to decrease the cardiac output and compensatory vasoconstriction. Furthermore, the worsening of hypokinesia and transformation in vasoplegia on the background of epidural analgesia was observed. The dynamics of creatinine growth during the first three days after eliminating of acute colonic obstruction is proportional to the reduction of diuresis with increasing degree of intraabdominal hypertention in the groups.
Conclusion. Neoliguric form of acute kidney injury is specific for patients with acute colonic obstruction and a risk of its development directly proportional to the initial grade of intra-abdominal hypertension.

Keywords: abdominal surgery, acute colonic obstruction, intra-abdominal hypertension, postoperative period, epidural analgesia, dynamics of creatinine growth, acute kidney injury
p. 551-560 of the original issue
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Address for correspondence:
344010, Russian Federation,
Rostov-on-Don, Nakhichevanskii pr., 29.
Rostov State Medical University,
department of anesthesiology and intensive care.
Tel.: +7 928 171-20-67
E-mail: stakanova1@mail.ru
Stakanov Andrey Vladimirovich
Information about the authors:
Stakanov A.V. PhD, Anesthesiologist of the Intensive Care Unit of 1, SBE RR "Rostov Regional Clinical Hospital", Assistant of the anesthesiology and reanimatology department, SBEE HPE "Rostov State Medical University", Applicant for Doctors degree of department of anesthesiology, reanimatology and transfusiology, faculty of advanced training and retraining of specialists, SBEE HPE "Kuban State Medical University".
Dashevskii S.P. Anesthesiologist, Deputy chief physician (medical work), SBE RR "Rostov Regional Clinical Hospital", Assistant of the anesthesiology and reanimatology department, SBEE HPE "Rostov State Medical University".
Musayeva T.S. PhD, Assistant of department of anesthesiology, reanimatology and transfusiology, faculty of advanced training and retraining of specialists, SBEE HPE" Kuban State Medical University".
Potseluev E.A. PhD, Head of the Intensive Care Unit, MBME "City Hospital 7 of Rostov-on Don".
Zabolotskikh I.B. MD, Professor, Head of department of anesthesiology, reanimatology and transfusiology, faculty of advanced training and retraining of specialists, SBEE HPE "Kuban State Medical University", Supervisor of the anesthesiology-reanimation service, SBME "Regional Clinical Hospital 2" of MH of Krasnodar Region, Vice-president of the Federation of Anesthesiologists and Reanimatologists of Russia.
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