Personification of perioperative biomonitoring
DOI:
https://doi.org/10.14739/2310-1237.2017.2.109663Keywords:
patient safety, intraoperative monitoring, S 100 calcium binding protein beta subunit, phosphopyruvate hydrataseAbstract
The number of perioperative monitoring methods is constantly increasing due to the achievements of modern science. However, an increasing number of indicators for monitoring and introduction of the newest monitoring systems was not enough to guarantee the exclusion of perioperative complications. Standard monitoring allows us to control the most common characteristics of homeostasis, the internal environment of the body, which are only a belated reflection of changes in energy-structural activity in the mass of cells in the patient's organism. Therefore, the life expectancy of operated patients does not reach the average life expectancy of the population.
Aim. Improvement in treatment results of patients with acute abdominal surgical pathology, by energy-protective perioperative management, based on personified energy-structural monitoring.
Materials and methods. The research was performed on the results of the study of energy-protective ability, anesthetic management and perioperative intensive care of 317 patients with acute abdominal surgical pathology. At all the stages of anesthesia management we analyzed the oxygen regime features, acid-base and water-electrolyte status, basal metabolic rate, indicators of oxygen transport, central hemodynamics and microcirculation, reliability of energy-structural activity (ESA), its properties, reserves and possibilities for autoregulation. Brain ischemia markers levels, neurospecific proteins S100 and NSE (neuron specific enolase) were additionally determined in venous blood serum by enzyme immunoassay at the main stages of monitoring.
Results. A close correlation has been established between early manifestations of neurons and glial cells damage and energy-structural changes in patient's organism. The strongest correlation is observed between energy-osmolar autoregulation and levels of cerebral ischemia markers (p<0,01). Inclusion of energy-structural activity, its properties, reserves, efficiency of autoregulation in biomonitoring, as its component, allowed knowing the degree of brain cells damage even in the absence of expensive and laborious studies of neurospecific proteins.
Conclusions. Supplementing the standards of perioperative biomonitoring with an audit of energy-structural activity (ESA) will allow not only to identify changes in the energy-productive capacity of the patient's body cell mass on time, but also to increase perioperative safety by using of advanced treatment strategy.
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