transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologiststransplantologiya-128Research ArticleАКТУАЛЬНЫЕ ВОПРОСЫ ТРАНСПЛАНТОЛОГИИACTUAL ISSUES OF TRANSPLANTATIONВлияние алгоритма интраоперационной рестриктивной инфузионной терапии, раннего начала энтерального питания и активизации пациентов на результаты ортотопической трансплантации печениThe effect of using the algorithm of restrictive intraoperative fluid therapy, early immune enteral nutrition, and early patient mobilization on orthotopic liver transplantation outcomesДзядзькоА. М.Dzyadz'koA. M.

отдел анестезиологии и реанимации 

к.м.н., доцент, заведующий отделом

Cand.Med.Sci. Associate Professor, Head of Anesthesiology and Intensive Care Department

2726996@gmail.comКатинМ. Л.KatinM. L.ЧугуноваО. А.ChugunovaO. A.МиновА. Ф.MinovA. F.ОгановаЕ. Г.OganovaE. G.СантоцкийЕ. О.SantotskiyE. O.ЩербаА. Е.ShcherbaA. E.РуммоО. О.RummoO. O.КанусИ. И.KanusI. I.УЗ «9-я Городская клиническая больница», МинскБеларусьCity Clinical Hospital No. 9, MinskBelarusГУО «Белорусская медицинская академия последипломного образования», МинскБеларусьBelarusian Medical Academy of Post-Graduate Education, MinskBelarus201613092016031020Copyright © Дзядзько А.М., Катин М.Л., Чугунова О.А., Минов А.Ф., Оганова Е.Г., Сантоцкий Е.О., Щерба А.Е., Руммо О.О., Канус И.И., 20162016Дзядзько А.М., Катин М.Л., Чугунова О.А., Минов А.Ф., Оганова Е.Г., Сантоцкий Е.О., Щерба А.Е., Руммо О.О., Канус И.И.Dzyadz'ko A.M., Katin M.L., Chugunova O.A., Minov A.F., Oganova E.G., Santotskiy E.O., Shcherba A.E., Rummo O.O., Kanus I.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/128

Травматичные хирургические вмешательства вызывают целый ряд патофизиологических реакций в организме, которые могут привести к развитию осложнений в периоперационном периоде, замедлить процессы восстановления и реабилитации и увеличить сроки госпитализации. Фаст-трак-хирургия, также известная как ускоренное восстановление после операции, или мультимодальная хирургия, направлена на снижение частоты послеоперационных осложнений, создание оптимальных условий для ранней послеоперационной реабилитации пациента и возврата к нормальной жизнедеятельности.

Результатом использования фаст-трак-программ является уменьшение длительности лечения пациента в стационаре без увеличения числа повторных госпитализаций. В настоящей статье продемонстрирован наш опыт применения компонентов фаст-трак-программы для улучшения результатов трансплантации печени. 

Major surgical procedures induce a number of pathophysiological responses, which may lead to a significant increase in perioperative complications, delayed recovery and rehabilitation, and longer hospital stays. Fast-track surgery, also known as enhanced recovery after surgery (ERAS) or as multimodal surgery, aims at decreasing the frequency of postoperative complications, creating optimal conditions for earlier postoperative recovery and return to normal life activities.

The implementation of fast-track programs results in a reduced treatment duration without increase in readmissions. In this article, we have described our experience in the application of fast track program components to improve the outcomes after liver transplantation.

фаст-трак-хирургияускоренное восстановление после операциитрансплантация печениfast-track surgeryenhanced recovery after surgeryliver transplantationReferencesEarly allograft dysfunction and liver transplant outcomes: a single center retrospective study / P.R. Salvalaggio, G.E. Felga, R.C. Afonso, B.H. Ferraz-Neto // Transplant. Proc. – 2012. – Vol. 44, N. 8. – P. 2449–2451. doi: 10.1016/j. transproceed.2012.08.002.Salvalaggio P.R., Felga G.E., Afonso R.C., Ferraz-Neto B.H. Early allograft dysfunction and liver transplant outcomes: a single center retrospective study. Transplant Proc. 2012;44(8):2449–2451. doi: 10.1016/j. transproceed.2012.08.002.Kehlet, H. Multimodal strategies to improve surgical outcome / H. Kehlet, D.W. Wilmore.– Am J Surg. – 2002. – Vol. 183, N. 6. – P. 630–641.Kehlet H., Wilmore D.W. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183(6):630–641.Newsletter transplant. International figures on donation and transplantation 2014. – EDQM, 2015. – Vol. 20. – 64 p.Newsletter transplant. International figures on donation and transplantation 2014. EDQM, 2015; 20. 64 p.Руммо, О.О. Коррекция ранних послеоперационных осложнений после трансплантации печени / О.О. Руммо // Клеточная и органная трансплантология. – 2014. –№ 2. – С. 116–121.Rummo O.O. Correction of early postoperative complications after liver transplantation. Kletochnaya i organnaya transplantologiya. 2014;2:116–121. (In Russian).Kehlet, H. Evidence-based surgical care and the evolution of fast-track surgery / H. Kehlet, D.W. Wilmore // Ann. Surg. – 2008. – Vol. 248, N. 2. – P. 189– 198. doi: 10.1097/SLA.0b013e31817f2c1a.Kehlet H., Wilmore D.W. Evidencebased surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248(2):189–198. doi: 10.1097/ SLA.0b013e31817f2c1a.Kehlet, H. Management of patients in fast track surgery / H. Kehlet, D.W. Wilmore // BMJ. – 2001. – Vol. 322, N. 7284. – P. 473–476.Kehlet H., Wilmore D.W. Management of patients in fast track surgery. BMJ. 2001;322(7284):473–476.Gatt, M. In response to: Varadhan K.K., Neal K.R., Dejong C.H., Fearon K.C., Ljungqvist O., Lobo D.N. Theenhanced recovery after surgery (ERAS) pathway for patients undergoing major electiveopen colorectal surgery: a metaanalysis of randomized controlled trials. Clin Nutr 29 (2010) 434–440. / M. Gatt, S. Khan, J. MacFie // Clin. Nutr. – 2010. – Vol. 29, N. 5. – P. 689–690. doi: 10.1016/j.clnu.2010.06.005.Gatt M., Khan S., MacFie J. In response to: Varadhan K.K., Neal K.R., Dejong C.H., Fearon K.C., Ljungqvist O., Lobo D.N. Theenhanced recovery after surgery (ERAS) pathway for patients undergoing major electiveopen colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29:434–440. Clin Nutr. 2010;29(5):689–690. doi: 10.1016/j. clnu.2010.06.005.Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®). Society recommendations / U.O. Gustafsson, M.J. Scott, W. Schwenke [et al.] // Clin. Nutr. – 2012. – Vol. 31, N. 6. – P. 783–800.Gustafsson U.O., Scott M.J., Schwenke W., et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®). Society recommendations. Clin Nutr. 2012;31(6):783–800.Miyaoka, Y. To divide or not to divide: revisiting liver regeneration / Y. Miyaoka, A.Miyajima // Cell Div. – 2013. – Vol. 8, N. 1. – P. 8. doi: 10.1186/1747-1028-8-8.Miyaoka Y., Miyajima A. To divide or not to divide: revisiting liver regeneration. Cell Div. 2013;8(1):8. doi: 10.1186/1747-1028-8-8.Blood and Transplant: annual report on liver transplantation. Report for 2013/2014 (1 april 2004 – 31 march 2014). Produced in collaboration with NHS. – England, 2014. – 76p.Blood and Transplant: annual report on liver transplantation. Report for 2013/2014 (1 april 2004 – 31 march 2014). Produced in collaboration with NHS. England, 2014. 76 p.Stickel, F. Role of nutrition in liver transplantation for end-stage chronic liver disease / F. Stickel, D. Inderbitzin, D. Candinas // Nutr. Rev. – 2008. – Vol. 66, N. 1. – P. 47–54. doi: 10.1111/j.1753-4887.2007.00005.x.Stickel F., Inderbitzin D., Candinas D. Role of nutrition in liver transplantation for end-stage chronic liver disease. Nutr Rev. 2008;66(1):47–54. doi: 10.1111/j.1753-4887.2007.00005.x.Sanchez, A.J. Nutrition for the Liver-Transplant Patient / Sanchez A.J., Aranda-Michel J. // Liver Transpl.- 2006. – Vol.12, N.9. – P.1310–1316.Sanchez A.J., Aranda-Michel J. Nutrition for the LiverTransplant Patient. Liver Transpl. 2006;12(9):1310– 1316.Dasarathy, S. Treatment to improve nutrition and functional capacity evaluation in liver transplant candidates / S. Dasarathy // Curr. Treat. Options Gastroenterol. – 2014. – Vol. 12, N. 2. – P. 242–255. doi: 10.1007/s11938-014- 0016-9.Dasarathy S. Treatment to improve nutrition and functional capacity evaluation in liver transplant candidates. Curr Treat Options Gastroenterol. 2014;12(2):242–255. doi: 10.1007/s11938- 014-0016-9.Комбинированное лечебное питание после обширных резекций печени / В.В. Киселев, С.В. Журавель, С.В. Царенко, А.В. Чжао // Общ. реа- ниматол. – 2007. – № 5–6. – С. 182–186.Kiselev V.V., Zhuravel' S.V., Tsarenko S.V., Chzhao A.V. The combined health food after extensive resection of liver. Obshch reanimatol. 2007;5-6:182–186. (In Russian).Preand postoperative immunonutrition in patients undergoing liver transplantation: A pilot study of safety and efficacy / L.D. Plank, J.L. McCall, E.J. Gane [et al.] // Clin. Nutr. – 2005. – Vol. 24, N. 2. – P. 288–296.Plank L.D., McCall J.L., Gane E.J., et al. Preand postoperative immunonutrition in patients undergoing liver transplantation: A pilot study of safety and efficacy. Clin Nutr. 2005;24(2):288–296.Masuda, T. Nutrition support and infections associated with hepatic resection and liver transplantation in patients with chronic liver disease / T. Masuda, K. Shirabe, S. Yoshiya // JPEN J. Parenter. Enteral. Nutr. – 2013. – Vol. 37, N. 3. – P. 318–326. doi: 10.1177/0148607112456041.Masuda T., Shirabe K., Yoshiya S. Nutrition support and infections associated with hepatic resection and liver transplantation in patients with chronic liver disease. JPEN J Parenter Enteral Nutr. 2013;37(3):318–326. doi: 10.1177/0148607112456041.Pilot study of preoperative immunonutrition with antioxidants in living donor liver transplantation donors / S. Nagata, K. Shirabe, K. Sugimachi [et al.] // Fukuoka Igaku Zasshi. – 2013. – Vol. 104, N. 12. – P. 530–538.Nagata S., Shirabe K., Sugimachi K., et al. Pilot study of preoperative immunonutrition with antioxidants in living donor liver transplantation donors. Fukuoka Igaku Zasshi. 2013;104(12):530– 538.Early postoperative enteral immunonutrition: clinical outcome and costcomparison analysis in surgical patients / M. Senkal, A. Mumme, U. Eickhoff [et al.] // Crit. Care Med. – 1997. – Vol. 25, N. 9. – P. 1489–1496.Senkal M., Mumme A., Eickhoff U., et al. Early postoperative enteral immunonutrition: clinical outcome and cost-comparison analysis in surgical patients. Crit Care Med. 1997;25(9):1489– 1496.

The authors declare that there are no conflicts of interest present.