International Medical Journal, Vol. 25., Iss. 2, 2019, P. 22−26.
TACTICS OF NERVOUS SYSTEM AND INTERNAL ORGANS PROTECTION AGAINST ISCHEMICINJURIES DURING SURGICAL TREATMENT OF ACUTE AORTIC SYNDROME
SI "V. T. Zaytsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine", Kharkiv, Ukraine
The technique to protect the nervous system and internal organs against ischemic injuries during surgical interventions for acute aortic syndrome is assessed. There was performed the analysis of 92 cases of patients treated for acute aortic syndrome. In each case, a complex of measures was used in their various combinations: hypothermia with additional local cooling of the patient's head, systemic and separate perfusion (selective perfusion of the brain, separate corporal perfusion). When performing a surgery in a simple compression of the aorta without perfusion, the surgeon is limited in time. The top of the left ventricle or arch of the aorta is used for taking blood, sending it to the femoral artery. As a shunt, it is convenient to use the aortic line of the artificial blood circulation apparatus, i.e. a passive bypass of the clamped site. The left atrial femoral shunting with centrifugal pump during surgeries in thoracoabdominal aorta makes it possible to perform them in an open heart. Hypothermic perfusion was performed with cooling of a patient until the brain bioelectric activity disappeared and oxygen consumption was minimal, which corresponds to the saturation of venous blood in internal jugular vein at the level of 95−98 %. The temperature in patient's oropharynx and rectum was 14−15 ° C. The main advantage of the proposed technique consists in the surgery safety for a patient.
Key words: acute aortic syndrome, treatment tactics, brain and internal organs protection.