transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2021-13-3-248-259transplantologiya-585Research ArticleАКТУАЛЬНЫЕ ВОПРОСЫ ТРАНСПЛАНТОЛОГИИACTUAL ISSUES OF TRANSPLANTATIONСравнительная оценка эффективности «либерального» и «рестриктивного» режимов интраоперационной инфузионно-трансфузионной терапии при трансплантации легкихComparative effectiveness of "liberal" and "restrictive" modes of intraoperative infusion-transfusion therapy in lung transplantationhttps://orcid.org/0000-0003-0830-2313ТалызинА. М.TalyzinA. M.

Алексей Михайлович Талызин, заведующий отделением анестезиологии-реанимации № 3

129090, Россия, Москва, Большая Сухаревская пл., д. 3

Alexey M. Talyzin, Chief of the Department for Anesthesiology and Intensive Care № 3

3 Bolshaya Sukharevskaya Sq., Moscow 129090

TalyzinAM@sklif.mos.ruhttps://orcid.org/0000-0002-9992-9260ЖуравельС. В.ZhuravelS. V.

Сергей Владимирович Журавель, д-р мед. наук, руководитель научным отделением анестезиологии, реаниматологии и интенсивной терапии

129090, Россия, Москва, Большая Сухаревская пл., д. 3

Sergey V. Zhuravel, Dr. Sci. (Med.), Head of the Scientific Anesthesiology Department

3 Bolshaya Sukharevskaya Sq., Moscow 129090

https://orcid.org/0000-0002-0746-1884ХубутияМ. Ш.KhubutiyaM. Sh.

Могели Шалвович Хубутия, акад. РАН, проф., д-р мед. наук, президент; заведующий кафедрой трансплантологии и искусственных органов

129090, Россия, Москва, Большая Сухаревская пл., д. 3

127473, Россия, Москва, Делегатская ул., д. 20, стр. 1

Mogeli Sh. Khubutiya, Academician of the Russian Academy of Sciences, Prof., Dr. Sci. (Med.), President; Head

3 Bolshaya Sukharevskaya Sq., Moscow 129090

1 Bldg. 20 Delegatskaya St., Moscow 127473

https://orcid.org/0000-0002-9616-1161ТарабринЕ. А.Evgeniy A. TarabrinE. A.

Евгений Александрович Тарабрин, д-р мед. наук, заведующий научным отделением неотложной торакоабдоминальной хирургии

129090, Россия, Москва, Большая Сухаревская пл., д. 3

Evgeniy A. Tarabrin, Dr. Sci. (Med.), Head of the Scientific Department of Urgent Thoracoabdominal Surgery

3 Bolshaya Sukharevskaya Sq., Moscow 129090

https://orcid.org/0000-0002-2824-1020КузнецоваН. К.KuznetsovaN. K.

Наталья Константиновна Кузнецова, канд. мед. наук, врач анестезиолог-реаниматолог, ведущий научный сотрудник отделения анестезиологии

129090, Россия, Москва, Большая Сухаревская пл., д. 3

Natalya K. Kuznetsova, Cand. Sci. (Med.), Anesthesiologist-Intensive Care Physician, Leading Researcher of the Anesthesiology Department

3 Bolshaya Sukharevskaya Sq., Moscow 129090

ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияN.V. Sklifosovsky Research Institute for Emergency MedicineRussian FederationГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»; Кафедра трансплантологии и искусственных органов ГБОУ ВПО «МГМСУ им. А.И. Евдокимова» МЗ РФРоссияN.V. Sklifosovsky Research Institute for Emergency Medicine; Department of Transplantology and Artificial Organs, A.I. Yevdokimov Moscow State University of Medicine and DentistryRussian Federation202121092021133248259Copyright © Талызин А.М., Журавель С.В., Хубутия М.Ш., Тарабрин Е.А., Кузнецова Н.К., 20212021Талызин А.М., Журавель С.В., Хубутия М.Ш., Тарабрин Е.А., Кузнецова Н.К.Talyzin A.M., Zhuravel S.V., Khubutiya M.S., Evgeniy A. Tarabrin E.A., Kuznetsova N.K.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/585

Введение. В последнее время значительное внимание исследователи уделяют стратегии интраоперационной инфузионно-трансфузионной терапии при травматических хирургических вмешательствах. Выбор «рестриктивного» режима во время операций во многих исследованиях позволил уменьшить частоту и тяжесть интра- и послеоперационных осложнений.Цель. Сравнить эффективность «либерального» и «рестриктивного» режимов интраоперационной инфузионно-трансфузионной терапии при трансплантации легких.Материал и методы. В исследование включены 58 пациентов, которым была произведена двусторонняя трансплантация легких в НИИ СП им. Н.В. Склифосовского в период 2012–2019 гг. Пациенты были разделены на две группы: в I группу (сравнения) вошел 31 пациент, общий объем инфузионно-трансфузионной терапии у которых составил 14 386,9±1310,0 мл (16,5 мл/кг/ч), II группу составили 27 пациентов с общим объемом инфузионно-трансфузионной терапии во время операции 10 251,3±740,1 мл (12,9 мл/кг/ч).Проведен анализ объема и состава инфузионно-трансфузионной терапии, объема кровопотери, клинико- лабораторных данных, длительности искусственной вентиляции легких, частоты интраоперационного применения и продолжительности использования после оперативного вмешательства вено-артериальной экстракорпоральной мембранной оксигенации, летальности.Результаты. При применении «рестриктивного» режима инфузионно-трансфузионной терапии при трансплантации легких установлено снижение объема интраоперационной кровопотери в 1,3 раза, объема трансфузии компонентов крови, в том числе свежезамороженной плазмы, на 37%, эритроцитарной взвеси – в 3,1 раза, аппаратной реинфузии аутоэритроцитов – в 1,56 раза. При этом выявлено сокращение продолжительности применения искусственной вентиляции легких в 2,7 раза, снижение частоты использования вено-артериальной экстракорпоральной мембранной оксигенации во время операции в 1,3 раза, уменьшение длительности применения вено-артериальной экстракорпоральной мембранной оксигенации после операции в 2,3 раза. Летальность в I группе составила 38,7% , во 2-й – 30,7%.Выводы. «Рестриктивный» режим инфузионно-трансфузионной терапии при трансплантации легких представляется перспективным направлением, требующим дальнейшего изучения и накопления опыта.

Introduction. Recently, researchers have paid considerable attention to the strategy of intraoperative infusiontransfusion therapy in traumatic surgical interventions. The choice of a “restrictive” regimen during surgery in many studies has reduced the incidence and severity of intra- and postoperative complications.Objective. Comparison of the effectiveness of "liberal" and "restrictive" intraoperative infusion-transfusion therapy in lung transplantation.Material and methods. The study included 58 patients who underwent bilateral lung transplantation at N.V. Sklifosovsky Research Institute for Emergency Medicine in the period 2012-2019. The patients were divided into 2 groups: the comparison group included 31 patients, the total volume of intraoperative infusion-transfusion in whom was 14386.9 ± 1310.0 ml (16.5 ml/kg/h). Group II consisted of 27 patients; their total volume of intraoperative infusion-transfusion during surgery was 10251.3 ± 740.1 ml (12.9 ml/kg/hour). The analysis we performed included the volume and composition of intraoperative infusion-transfusion therapy, the volume of blood loss, clinical and laboratory data, the duration of mechanical ventilation, the frequency of intraoperative use of veno-arterial extracorporeal membrane oxygenation and the duration of its use after surgery, mortality.Results. When using the "restrictive" fluid therapy for lung transplantation, we observed a decrease in the volume of intraoperative blood loss by 1.3 times, the volume of transfusion of blood components, including fresh frozen plasma by 37%, erythrocyte suspension by 3.1 times, and instrumental reinfusion of autoerythrocytes by 1.56 times. At the same time, we revealed a decrease by 2.7 times in the duration of the mechanical ventilation use, a decreased frequency of using veno-arterial extracorporeal membrane oxygenation during surgery by 1.3 times, and a decreased duration of using veno-arterial extracorporeal membrane oxygenation after surgery by 2.3 times. Mortality was 38.7% in group I, and 30.7% in group II.Conclusion. The “restrictive” approach to intraoperative infusion-transfusion therapy in lung transplantation seems a promising new trend requiring further study and gaining the experience.

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