Infusion therapy: methodology, methods, enteral and parenteral feeding, treatment and acceleration. Infusion therapy

For a quote: Malishev V.D., Vedenina I.V., Omarov Kh.T., Fedorov S.V. Criteria for infusion therapy in patients with hypovolemia // RMZ. 2005. No. 9. P. 589

Infusion therapy (IT) is the main non-listed component of intensive therapy for hypovolemic conditions. In case of severe hospitality hypovolemia, there is no need for extravagance, the first for everything is the renewal of the circulating volume of blood and postpartum birth. Zvyyy for tsiy to introduce a great obsyag of old - colossal and crystalline razchinіv. At the same hour, during the infusion therapy, it is necessary to find a number of officials, such as those who can lay down an unprecedented result of treatment: the steps of hypovolemia, the reason, the patient, the manifestation fellow sickness... It is important to note the information and storage of the infusion centers. It is necessary to take the steps of hemodilution, the osmolarity of the plasmas, the growth of the blood in the water. On the other hand, in the most important cases of hypovolemia, additional drug therapy is required, it is focused on the renewal of the heart wikid (HR), the deterioration of judicial regulation, tissue hypoperfusion.

Overhaul of colossal differences from hour IT can lead to overwhelming of the heart-vascular system. At the same hour, for the achievement of one and the same hemodynamic effect, the crystal breakdowns are guilty of 2-4 times more, lower than those of the coloids, and the hour of the internal introduction is significant. The zalny obsyag of ridini is not guilty of perevischuvati singers between. Internal therapy is based on the concept of high-level infusions, which can be transformed into references at the age of one, in this hour you cannot be completely grounded. "Highly intensive IT" can lead to the development of serious acceleration: a clerical embryo, the deposition of a line in the third water space, a deterioration of the function of the heart-vascular system, and multiple organ deficiencies with a lethal result.
It has been established that there is a lethality in what is caused by an infusion in the perioperative period. The increase in mass by 15-20% in proportion to the extreme value of the supernatant will lead to a high lethality. All of the time has spoken about the prelude to the development of new methods of balanced and new therapy, based on the criteria of dynamic control of parameters in central and peripheral hemodynamics, water sectors, duresis and transport of acid. In all cases of blood loss, or dehydration, the basis of the treatment is the renewal of the internal vascular volume, the anterior vascularity and the heart disease (SV). For zmenshennya zagalnogo obsyagu perelivaєtsya rіdini proponuєtsya vikoristovuvati visokoosmotіcheskіe іnfuzіynі rozchini scho spriyayut priskorenomu transition rіdini of іnterstitsіalnogo i klіtinnogo aqueous rozdіlіv in sudinny sector ( "maloob'єmna IT"), i pid hour іnfuzіy zastosovuvati іnotropnu pіdtrimku abo organosohranjajushchie terapіyu. In fact, there are ways to get the "norm-volume IT". The average recommended value of hematocrit is guilty but equal to 30% (0.30), and transportation of sour - up to the norms [(DO2 520-720 ml / (min.xm2)] or else it is good to eat. the post-infusional expanses of power and the power of the infusions themselves - those of the organisms.
Water was distributed to the body in the norm and pathology. Ridina of human tila is located in post-ruin Russia. In the minds of the state gipovolemia, where there is a change in the vastness of the water, the BCC cannot be physiologically consistent in size. Obviously, the main criterion for the balance is the adequacy of the heart-vascular system in the case of a regular revision.
In the generalized version of the zagalnaya ridina (ObschZh), in the stratum of the people, the warehouse has 60% of the mass tila (MT). Ossyag internal development (VnuKZh) is up to 40%, and pozaklitinnoy (VnuKZh) - interstitial, transcellular and intravascular - 20% MT. In such a rank, obsyag Obshch in an older person with a weight of 70 kg, up to 42 l, volume VnuKZh = 28 l, volume VneKZh = 14 l (5 l - bcc, 8 l - interstitial ridina, 1 l - transcellular ridina) ... Unimportant to the great obsyag of a foreign country, the gostra wasted all 1-1.25 liters of blood or dehydration with a deficiency of 5 liters of extracorporeal blood, and more can lead to a lethal result. Obviously, in ailments with a low bcc and a volume of extra-QOL, a lethal result can come more quickly. The development of ways to ensure the speedy renewal of the internal vascular system for a patient's water resources is one of the development of the current IT.
Pathological changes in water sectors and homeostasis constants in children
Patients of a sickly and old age have the following meanings: a decrease in the amount of age up to 45-50% MT, a decrease in VneQZh, an increase in fatty tissue, a decrease in tolerance to a water-optimized level, a tendency to concentration. As hypovolemia, so hypervolemia becomes very important, a high degree of IT is contraindicated due to a decrease in the compensatory capacity of the heart-vascular system.
In lithium ailments, who suffer for obesity, there is: a decrease in the total amount of up to 40-35% MT. In young women with obesity, there is a total reduction of up to 30% MT. Critical changes should be insisted with an intake of 1-2 liters of extra-QOL, a small change in the blood pressure before the sequestration of the age, embryo, and the change in the heart-court system.
Ailment due to congestive heart deficiency is characterized by: an increase in VnuKZh, unimportant in case of a critical condition, up to 12-15 liters, a manifestation of hypovolemia and a decrease in the heart wikid. IT vimag of special care, binding to the monitoring of hemodynamics and water balance.
Hypoalbuminemia, vikhidna or vynikla before the hour of IT, to reduce the general target value and increase the amount of money to be paid. Decrease of colo-osmotic vice (CODE) of plasmas lower than 20 mm Hg. not considered, and below 15 mm Hg. become a serious threat to the life of the sick. A decrease in the albumin plasma level below 30 g / l can be caused by a negative loss of blood, as well as by an innovative hemodilution. Vikoristannya heterogeneous coloidal differences cannot last a trivial hour before the permissible CODE of plasmas.
Oliguric form of nirkowal deficiency and oliguria, which is a winnickl for an hour, new stage- a lot of legends.
Septic shock is characterized by significant reductions in circulating redness, heart deficiency, vasoplegia and vasoconstriction, the emergence of ridin from sudin in conjunction with the increased penetration of capillaries, polyorganic deficiency. Out-of-QOL deficiency reaches 5 liters or more. Investigation of the circulatory system, vicorisation of the infusion of the middle, the introduction of the bcc, inotropic and vasoactive preparations.
Hypo-osmolality due to lower osmolality of plasma lower than 280 mosm / l and less sodium in plasma lower than 125-120 mosm / l in the stages of treatment is not safe, it is very hard to produce until the decrease in fat For the renewal of the normal level of osmolarity by plasmas (280-300 mOsm / l), it is highly toxic, and for severe hyponatremia - hypertonic solution to sodium chloride. Rozchini tsukrіv, yakі є donators of water, counter-indications.
Plasma osmolality increase in food of 300 mosm / l, increased by hypernatrium or hyperglycemia, supervised transfer of the line from the internal space into the space of the tinny, bringing the debris to the cells. Hyperglycemia with adjustments to the level of glucose in the blood to produce osmotic stimulation of diuresis and hypovolemia. In case of hypernatrium with a little sodium, 150 mmol / l should be taken into account, and drugs should be taken to avenge sodium. In case of hyperglycemic vikoristovuyut isotonic or hypotonic sodium chloride, to carry out a dose of insulinotherapy.
Mill of the brain for an hour of internal introduction of a line. The amount of osmolality of the line is poured into the interior of the internal line. The minds of the building are seized by significant changes, they will be able to take the lead for additional variation of the internal particles (molecules). However, the values ​​of the osmolality change of the extra-QOL can lead to the raptus zsuvu obsyagu klitin to the brain. In such a rank, it is important to reduce the osmolarity of plasmas in the range of 280-300 mosm / l.
Decrease in hemoglobin of blood below 80 g / l and hematocrit below 20% is a critical boundary, behind which there is a turn of change in transport, which is the most important criterion of current infusion therapy. If the decrease in the number of indicators is natural when the blood loss is significant, then it can be reduced as a result of hemodilution.
best parts of the cause state government:
Bleeding supravodzhutsya swings in the parameters of hemodynamics. The steps are to lay down in volume and blood loss. Gostra blood loss of 25% BCC without IT can lead to a lethal result.
Abnormal injecting of ridin through nirkas (non-blood and hypochondriacal diabetes, lack of supra-nirkoval zenosis, diuretics); through the shlunkovo-intestinal tract (blues, nasogastric tube, diarrhea, intestinal drainage); through the shkira (overwhelming fatigue, mucoviscidosis).
Relocation of birth to the third water space:
- in case of peritonitis, there is a deposit of a significant debridement of the post-mortem age in the black empty and in the intestinal lumen;
- in case of pancreatitis - deposition of birth in the umbilical space, in the black empty space, in the sub-and sub-phrenic spaces;
- at intestinal imperfections in the intestinal enlightenment, there can be a lot of obstructions in the intestines, there can be a few years of age, which is supervising a significant increase in the vice, some of the mucous membranes;
- at great opera Because of the great traumatization of tissue, there is an accumulated length of time in the area of ​​operations during the operation of tissue tissue, the transition of the line into the wall, or it enlightens the intestinal tract (QCT) during operations on the new one.
The third water space is characterized by the purchases of the homeland, as it is not available at the same time for the internal, as well as for the backwater space, in connection with which the sick person is encouraged to have the important signs of a large wine definition. The third water space is not in the minds of a normal normal exchange.
It’s important to get the steps of hypocrisy. Decrease in mass, such as a number of clinical indicators, an indicator of the deficiency of post-class birth.
With a decrease in oil mass by 10-15% clinical symptoms They lead to important degradation, and if the weight is reduced by 15-20%, a fatal result can occur. Symptoms of gastrointestinal hypovolemia are presented in table 1.
For an hour it is important to ensure the possibility of a very good increase in extra-QOL, that is, hypervolemia, which can lead to cardiac insufficiency. Її reasons can be:
- superfluous infusion therapy;
- a decrease in deiurezu (a decrease in sodium and water);
- moving the line from the interstitial space to the plasma.
Prior to compensatory mechanisms of hypervolemia, the atrial sodium vikid peptide is introduced.
Symptoms of hypertension are presented in Table 2.
Improvement of masi tila is an indicator of hypervolemia. The lethal result of mobility when the weight is increased by 15-20%.
Rozpodil of infusion centers in the open spaces of the body
coloïdni razchini
Blood and blood components є autogenous coloidal spines, which only increase the intravascular part of the posterior origin. It is indicated for blood loss of 20% BCC or more. The city of shelter in the Danish hour stagnates even more rarely. Erythrocyte mass is vicorized for increasing sour blood with a hematocrit lower than 30%. Freeze-frozen plasma is poured over with the head rank with the mark of renewal of officials from the blood, corisne for renewal of the volume of blood.
Albumin in a buffered salt solution is dispensed in 5% and 20% concentration, osmolarity is likely to become 300 mOsm / l and 1200 mOsm / l. Vikoristovuєtsya for the improvement of the obsyagu and the oncotic grip of plasmi. 20% albumin zbilshu sudinniy volume for 3-4 ml for skin 1 ml of injected rose.
Dextran and starch є with heterogeneous coloidal striations, to increase the intravascular part of the pozaklitinny volume of ridini. Rzchini dextran or starch to inject quickly, in quantity, sufficient for adequate tissue perfusion without re-entangling of the heart-vascular system. Їх is the maximum one-time and the dobova dose is innocent but more than 15-20 ml / kg. Do not go to waste for renewal of the circulating volume of the country. Decreased doses (often not primed) can lead to early acceleration: decreased activity of the blood system and blood loss, deterioration of the function of small organs, development of dextran nirka. It is not a matter of stagnation in case of nirkovy deficiency.
crystal clear
Ozotonic (0.9%) resistance to sodium chloride is lower all the way from the court to the interstitial sector. From 1 liter of internal transfusion of 0.9% sodium chloride in the vessels, 200 ml is left, and 800 ml goes into the interstitium. In the cell, there are no problems due to the physiological effect of the calcium / sodium pump. Oskіlki the main Ingredients VneKZh є sodium and chlorine, residues in case of hypovolemia є all are indicated for storing a wide range of problems.
The concentration of the solution (7.2-7.5%) to sodium chloride occurs in a short-hour, ale-swelling effect, causing a change in the size of the line in the vessels for a breakdown of the line from the interstitial sector, possibly, from the inner arms. The whole effect of the growth of osmotic clutches in vessels and other water breaks. Yogo can be continued, as soon as one hour with hypertonic razchin to introduce coloidal razchini.
Roschini Ringer lactate, lactasol, Hartmann may be balancing the warehouse of electrolytes, building compensations for the isotonic deterioration of hydro-ionic energy. The stench is shown in order to replace the deficiency of extra-QOL in case of an important acid-base balance or mild acidosis.
5% of glucose levels, for glucose does not increase in size in the vessels, it grows more importantly in the interstitial and interstitial spaces. We need to become a head rank for replenishing the supply of fresh water in the body. The stench is necessary for hospitality in one hour, not just salt, but water.
Calcium and magnesium are indicated in all types of drops at the same time. Smell the stench to get stuck in the event of the liquidation of insecure hemodynamic breakdowns and oliguria, in the presence of a deficiency in the development of the disease.
The solution to chloride or calcium gluconate is indicated only for hypocalcitis (for example, with pancreatitis) or hypercalcitis. Calcium in the Danish hour is not victorious і before the hour of reanimation. For the period of hypotension, vasoconstriction is possible, without affecting the normalization of the systemic arterial vise. The whole phenomenon can be explained by the accumulated calcium ions in small ishemian cells of smooth juices of sudins.
Infusion therapy for treatment new forms state government
Peritonitis. In case of severe diffuse peritonitis, the inlet of a line reaches 4-9 liters, which leads to the development of hypovolemic abo septic shock. The stage of degradation can be judged from the clinical picture. Stage I (line deficit is close to 2 l): tachycardia, orthostatic hypotension, AT in the lying position is normal. II step (deficiency is close to 4 years): apathy, falling of the arterial vise in the lying position. Stage III (deficiency 5-6 years): loss of evidence, shock, fall of systolic arterial vise in the lying position below 90 mm Hg, thickening of blood, swelling of microcirculation. Paralysis of the intestine, bloating, reducing the condition of living and increasing the deficiency of ridin. The loss of sodium is even more significant, it should be produced most often to isotonic, and later - to hypotonic form of dehydration. Deficiency of calories of accumulation caused by a drop in blood and transmineralization. During the exudation in worms and catabolism is caused by the loss of the battery. The adjustment of organic and inorganic acids leads to metabolic acidosis. At the same hour, the intake of acidic shlunkovy instead of a metabolic alkalosis.
With decreased systolic arterial vise lower than 100 mm Hg. to slow down the catheterization of the central vein and to introduce coloids with the help of renewed circulation. A lot of stagnation can be applied to starch (Refortan, Berlin-Chem) or low molecular weight dextran in a gallant dose of up to 1-1.2 liters, sometimes (or one hour) isotonic electrolytic solutions, like removing sodium and chlorine. The introduction of 5% or 20% albumin is shown. Injecting calories at glucose levels for a liquid shock and a sufficient amount of energy. The initial dose of infusion breakdowns, including and breakdown of glucose, becomes approximately 2.4-3 l / m2 for 24 years. When the pace of the cob infusion of colossal breakdowns is high, it is guilty that the rate is high. If the hematocrit is lower than 30%, enter erythrocyte mass. Vimіryuyut CVP, with podvischennі іgo vische 12-15 cm water column. The rate of infusion is reduced, if necessary, it can be used as an infusion. In case of a reduced dureis, manitol or other diuretics are indicated.
If the shock is trivial і nabuv to the nature of the septic tank, then it is necessary to take the SV and the delivery of sourness to the fabric. Heart index (СІ) is guilty but not less than 4.5 l / (minxm2); delivery of acid - not less than 500 ml / (minxm2), average AT - not less than 80 mm Hg, OPSS in between 1100-1200 dinxs / (cm3xm2). To increase the delivery of acidity to tissue, increase the hemoglobin level of blood up to 100-120 g / l, increase the level of blood hemoglobin - PaO2 is 75 mm Hg, the amount is not less than 90%.
Pancreatitis When shots are transfused albumin, protein, plasma, one heterogeneous coloidal solution - low molecular weight dextran or hydroxyethyl crochmal (200 / 0.5). Perevagu sliddavati bilkovy great razchiniv. Obov'yazkovy crystalline solutions of electrolytes and glucose. Monitor hemodynamic indicators. With a reduced durezi - manitol. You can get stashed by a forced dyuresu. With a turn of hypotension, a good result can be obtained by removing the internal introduction of calcium chloride by means of a path. Upgrade the parameters of the acid-puddle mill, instead of electrolyte plasmas and assimilate the deterioration.
Kishkova lack of deterioration. As a result of a breakdown in the passage in the shlunkovo-intestinal tract, the exchange of water and electricity is ruined. Obsyag rіdini, who take the fate of etching in 24 years, become half of all debts Outside QZH, or 2-3 times overwhelming plasmas. Hypovolemic shock develops as a result of the growing deficiency of birth. The intestines can accumulate up to 6-8 liters of rіdini, in the intestinal tract і 2-3 l. Obsyag postaklitinny space rapidly change, the thickening of blood and change in the inner space. Injection of sodium until isotonic or hypertensive dehydration. Deficiency of calories of accumulation in waste from the shlunkovo-intestinal tract, loss of blood and other factors. Calcium deficiency to produce up to intestinal atony. The function of nirok will break down. In case of shots, enter coloids of 1-1.5 l, izotonic electrolytic roses, in case of deficiency, add albumin. When there is a shock, it is inaccurate to repair therapy with electrolytes and infusions. The fluidity of the infusion and the amount of infusion mediums is determined according to the clinical symptoms and parameters of blood circulation. The initial dose is injected in the first 24 years, reaching 2.4-3 l / m2 tila.
Hemorrhagic shock. Methods of little-needed infusions. In the remaining hour, the technique of low-volume infusions of salt hypertonic problems became widely used. Both in the experiments, and in the clinics, the health of hypertonic changes (HR) was brought to sodium chloride to produce a systemic arterial vise, SV, to reduce microcirculation and visibility. The novelty of the method of polarization, pro-proponated by the authors, is in the rejection of the innocent effect of polishing the central hemodynamics for rakhunok flow of ridini in the court from the interstitial and clerical water spaces. Intravenous infusion of a small amount of 7,2% or 7.5% of the sodium chloride range to produce underdeveloped, albeit suttuve osmolarity adjustment of plasmas (7.5% of the sodium chloride range from an osmolarity of 2400 mol / liter). Zagalny obsyag 7.5% of sodium chloride to become 4-6 ml / kg MT. Introduce yogo in a dose of 50 ml with small interruptions (10-20 minutes). GH infusion kombіnuyut of 6% dextran 60 rozchinom abo rozchinom gіdroksietilkrohmalyu (Refortan) 200. When tsomu utrimannya vіdshkodovanogo vnutrіshnosudinnogo ob'єmu vіdbuvaєtsya protyagom trivalogo hour for rakhunok mobіlіzatsії endogennoї pozasudinny rіdini vnaslіdok stvoryuvanogo osmolality gradієnta vise mіzh membranes klіtin i sudinnoї stіnkoyu. GH transfusion should be tightened with stable hemodynamic parameters. On the thought of pre-eminent people, the method was introduced, the introduction of a hypertonic salt rose quickly increases the arterial vise and CB, the preloading and lowering of the OPSS, efficiently corrects the lack of hypertonicity in the reduction of perfusion. However, it should be respected that the treatment of GH in case of hemorrhagic shock does not include the need for the development of globular obscuration, blood plasma and all deficiency of ridin. Slide mothers on uvaz, as a result of salt GR can be inflicted on a negative inotropic effect (possibly, in connection with the damage to the caloric balance in the myocardium). It is important not to change the setting of the GR dose. The most available accelerated method is the hyperosmolar stun. Call it bad and not good therapy. If the bleeding is not zupinenno, then vicoristannya GR can be more feasible.
Internal organ-preserving therapy. The whole method of implantation is based on the fact that a small dose of inotropic agents will turn microcirculation in tissues and perfusion in tissues and organs. Stasis in the presence of a significant IT community, especially in the sick of the kidnapped and old age. The procedure for coloid-crystalloid therapy from the ear itself of infusions is to establish the internal system with dopamine. Vikoristovuyt small doses of dopamine 1-1.5 mcg / (kgxmin) during the period of infusion therapy. The method of testing in sick people with a kidney disease during operations to drive peritonitis and intestinal obstruction. Winning a change in the postal service of internal infusions.
criteria of adequacy
infusion therapy
Central hemodynamics. The central venous vise (CVP) is the key in diagnosing the causes of heart failure and additional help in diagnosing IT problems. Introduce a catheter in the central vein and reduce the CVP. CVP CVP> 12 cm H2O abo> 8 mm Hg, LAD> 30/15 mm Hg vkazuyut on the perevantazhennya rіdinoyu, ruined the function of the right lumberjack or pіdvischennya legenevogo judiciary support.
Peripheral hemodynamics. Warm, dry and horny skin is a sign of adequate peripheral perfusion, but cold, the skin of the skin is transferring deteriorated perfusion.
Pulse oximetry, krym sichennya blood sour, allowing for the increase in pulse rate and assessment of tissue perfusion Increased signal can be reduced in peripheral vasodilatation or increased heart wikidia (SV), and low amplitude can be accumulated by vasoconstriction or low SV. Systolic AT Dyuresis. Nirki - the main regulator of the balance of the drive and electrolytes. Dyuresis is an important criterion for assessing the status of central and peripheral hemodynamics. Normal dehydration - 50 ml / year (0.7 ml / kg / year), by decreasing -> 30 ml / year (0.5 ml / kg / year), significant reductions (oliguria) - Ridinny probes based on dynamic CVP і / abo the grip of the wedging of the legene capillaries (DZLK) in the IT process. CVP is necessary in all cases, if the reason for the hypotension is unclear. In cich vipadkah, injecting the CVP inject 250 ml of coloidal rosch with a stretch of 15 minutes. I know the CVP. Yaksho CVP moving by 2-3 cm of water column. і the hemodynamics was dyed, the cause of heart failure є hypovolemia. It is shown further the introduction of infusion solutions. If there is a lack of water supply, CVD is normal, then the reason for the hypotension is heart failure. Slide to pinch the internal introduction of a second and to use inotropic therapy. In case of an established hypothesis, it is necessary to see the information about the insertion of the catheter into the legendary artery... DZLK in between 6-12 mm Hg. Vvazhaєnim physiological optimum, on the approach of which and next to straighten out the Zusilla. However, in the process of IT clinical polyphenia, increase the range of DZLK in the range of 12-16 mm Hg, DZLK 16-20 mm Hg. - and if you want to install it.
If hypervolemia has been brought and signs of a number of legends, the internal introduction of ridin has been proven, further therapy is carried out with the help of inotropic and vasoactive agents:
1. In case of cardiogenic shock and systolic AT 2. Dobutamine indications in case of systolic AT 80-100 mm Hg. The pochatkova dose is 5 mcg / kg / hv internally in drops. When the day is out, the dose of dobutamine is increased by 5 mcg / kg / hv skin 10 min until reaching maximum dose 20 μg / kg / min.
3. With a high systolic AT and a rosy incubation of legends, the protection of nitrate intake is shown (nitroglycerin 0.3 μg / (kgxmin) or dinitrate isosorbid 2 mg / year). The dose of the drug is gradually increased until the required effect is removed. Furosemide 40-80 mg vnutrіshnovennostozoyut for one hour.
For a differential assessment of hemodynamics, three main indicators are suggested: heart wikid, DZLK and OPSS (external peripheral description, which in the norm can become 1200-2500 dynxs / (cm3xm2). I’ll become.
Hypovolemic shock is characterized by low PSLK (low SV) and high OPSS.
Cardiogenic shock is supervised by high DZLK (low SV) and high OPSS.
visnovok
Discussion among hikers new years to the victoriousness of that chi іnshogo kind of rіdini (this is the name of the coloidal-crystalline vіyna), in our opinion, it is guilty of ending with a physical physiological approach before carrying out IT. As soon as it is necessary to quickly liquidate the deficiency of the bcc, then more beautifully than vicoristovuvati coloidens. Їх efficiency to accumulate as a molecular mass, which is due to the value of the volumetric efficiency. Call it vicious at once with the isotonic solutions to sodium chloride and glucose. Hypertonic salt solutions, such as concentrated coloidal problems, create a large amount of plasma for the water resources of the most ailing, and the effect is to be reached when small claims are made. At the same hour, during dehydration without the development of hypovolemic shock, the degree of reduction in the amount of hypotension in sodium chloride does not occur. The main storage facilities for the degradation of the state of affairs are the separation of electrolytes, sodium and chlorine, as well as the distribution of glucose or glucose, which is necessary for the safety of the body with clean water. In such a rank, the establishment of a coloids / crystals cannot be of a constant value, it can be 1: 1, 1: 2, and 1: 3, but it can be found in a particular situation. In a number of vypadkіv there can be a number of vikoristanі, tіlki crystalloіdnі rozchini, coloіdnі rozchini vimagayut, as a rule, storing and crystalloіdnіv. In case of blood loss, the placement of colossal breaks and blood can be equal to 1: 2 and 1: 3. not safe heritage"Hyperinfusion" can be unique for the monitoring of the central and peripheral hemodynamics, for the monitoring of inotropic and vasoactive drugs, the storage of hypertonic levels of sodium chloride, for the weather assessment of the diuresis.
In case of elimination of the state of hypovolemia, there are two stages of internal and drug therapy. Stage I: active activities, directing to the renewal of hemodynamics, transport and function of nirok. Zdijsnyuєtsya to finish rough correction (lіkuvannya shoku, olіgurії, ruin gas warehouse arterial blood, wastewater treatment plant). During the period, it is especially important to monitor hemodynamics, vimiryuvati deiuresis, blood gas initiation, CBS and other indicators. Stage II is to be repaired for liquidation of insecure manifestations of hypotension and shock. On the whole stage, a fine correction of all basic constants of homeostasis is carried out: SV, duresis, osmolality, electrolyte balance, destruction of CBS, hemoglobin. At the same time, hemodynamic stability is reached at stage I and cannot be a criterion for the general well-being of a sick person. Accept either infusion of heterogeneous coloids and other blood cells, switch to infusion of erythrocyte mass, albumen, plasmas, to avoid the need for water, energy supply, energy supply.

literature
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Dzherelo did not go

Indicated before infusion therapy: substitution of out-of-pocket inputs, protection of the body's needs (including carbohydrates, drinks, fats), storage of current, or parallel, inputs.

Likar, who has an attack before infusion therapy, is guilty of the keruvatis by the offensive principle: the deficiency must be stored at the end of the process of CBS and the water-electrolyte balance. To use the current ones, you can use the table (average requirement in mils per 1 m 2 of surface for 1 add). Dodatkovі pathologіchnі іtrate sіdnuvnuvati strictly mіlіlіtr for mіlіlіtr. Vrahovuvati is not only a small part, but a warehouse is consumed with juices and old.

The main meta of infusion therapy is to quickly memorize the apparent deficiency of water. The optimal dose of the first 45 mins is 360 ml / m 2. Infusion problems are not guilty of a great number of electrolytes, the transfer of glucose is 5%, the range of Ringer or Ringer-Locke. Accelerated sechovidіlennya inform about the correctness of the reverse dose.

Even though the growth is not due to the growth, the rate of the introduction of the line is more than 120 ml / m 2 The process of renewal of the involved debts can be started before the correction of the deterioration of the waste water treatment and the water-salt balance, as the body itself does not compensate itself until the moment.

For the emergence of current or parallel expenditures and time-saving therapy, it is necessary to find a retreat. A regular obsyag of birth, which will eliminate ailments, which is to be found on parenteral nutrition, may be expensive in jars for incisions, visions from wounds and fistulas, intestines and intestines. If we are sick, if we are in a coma, catheterization of the slash is required.

Successful therapy is to be found in the past and in the increasing losses, as well as daily consumption in the country. Repeated pozaklіtinnі vtrati rіdini (with blues, carrying, through fistulas) change the balance.

Great value is the smallness of the inflow, and the small amount of acceleration of the wine as a result of the forced or insufficiently quick (with shots) introduction of the ridin. In case of an important form of deficiency, the renewal of the equivalent circulation is introduced by a large amount of birth. Infusion 2000 ml / year of isotonic growth in case of isotonic dehydration does not accelerate, the process of AT only stabilizes, it is necessary to change the frequency of dribbles.

ROSCHINI FOR INFUSION THERAPY

For its own characteristics, all decisions can be distributed on the step of a group (W. Hartig, 1982):

1. deputies of the internal and external birthdays [Show]

   Substitutes of the post-consumer origin є 2.5%, 5% and 10% of the range of candies with a small number of electrolytes or without them. Basically, the sign of cich razchin is the assertion of the deficiency of water in the pozaklitinny sector. It is not possible to inject internally distilled water, as it is hypotonic in terms of the rate of release to erythrocytes and cyclical hemolysis. The transfusion of the varieties of candies before the hemolysis, the water from them grows more and more, in the world of vitratic glucose, for the approval of the glucogen, and at the same time it is developed between the poses and the inner space.

   In the classroom practice, vikoristovuyut izotonichny razchin sodium chloride. Yogo priznachayut at bagatokh get sick, if you want to get yogo maє buti suvoro amber (sodium deficiency with supra shlunk juice). Behind the warehouse physiological breakdown It is more correct to call it non-physiological, since in 1 liter of 0.9% sodium chloride there is 154 mmol / l of sodium and chlorine (in the unconditional blood plasma it is 142 mmol / l, chlorine - 103 mmol / l). Thus, at a time of 1 liter of 0.9% sodium chloride, a surplus of sodium (12 mmol / l) and chlorine (51 mmol / l) is injected into the space behind. This disproportion is significant to the visual function of nirok. However, the process of capturing water and sodium (before pouring in aldosterone and vasopresin) makes it possible to save physiological conditions. Apply sodium and chlorine to the body until it is vitrified with Сl ions - equivalent quantities of ions НСО -, as a result of which hyperchloremic metabolic acidosis... Ozotonichesky razchin sodium chloride is not to blame, but only one deputy of Ridini in period of operation... Adding up to 5% glucose distribution will relieve the organism as a re-entanglement with electrolytes and give the possibility to drink water at once with the exchange of rechovins in any of the products. The ideal deputy of the incurred past birth є Hartman's ideas.

   Sodium hydrocarbonate is the main solution for the treatment of metabolic acidosis. Before the vicoriannya sodium lactate, it is carefully placed in the edge. Mechanism of sodium lactate polyagi in that, by way of oxidation to Nanso 3 and CO 2 to produce an increase in the concentration of HCO - in the post-clotting sector. Otzhe, the introduction of sodium lactate pіdvischu sosivannya sisnya, which is not good for hypoxia of any type. In addition, with impaired glucogenogenic liver function or extracorporeal blood circulation (and sometimes and spontaneously), the metabolism of lactate increases. In some cases, infusion can be caused by obvious metabolic acidosis, but the lethal result becomes inevitable. In addition, in the case of metabolic acidosis correction, hydrocarbonate is guilty of a preserving role.

   Deputy ministers of the past
   rozchin	subtlety	Energy value		Na +	Before +	Ca 2+	Cl -	lactate
   		kj	kcal	mmol / l
   Ridini without electrolytes:
   2.5% aqueous solution of glucose (25 g)	hypotonic	418	100	-	-	-	-	-
   5% aqueous solution of glucose (50 g)	isotonic	837	200	-	-	-	-	-
   10% aqueous solution of glucose (100 g)	hypertonic	1674	400	-	-	-	-	-
   5% water solution of invert zukru (50 g)	isotonic	837	200	-	-	-	-	-
   10% water solution of invert zukru (100 g)	hypertonic	1674	400	-	-	-	-	-
   10% aqueous fructose roschine (100 g)	hypertonic	1674	400	-	-	-	-	-
   5% alcohol, 5% aqueous solution of glucose (50 g)	hypertonic	2322	555	-	-	-	-	-
   Determination of the solution (without calories) based on 0.9% solution of sodium chloride:
   2.5% rose glucose (25 g)	hypertonic	418	100	154	-	-	154	-
   5% roschin glucose (50 g)	hypertonic	837	200	154	-	-	154	-
   10% rose glucose (100 g)	hypertonic	1674	400	154	-	-	154	-
   10% roschiny fructose (100 g)	hypertonic	1674	400	154	-	-	154	-
   5% invert zukru (50 g)	hypertonic	837	200	154	-	-	154	-
   10% invert zukru (100 g)	hypertonic	1674	400	154	-	-	154	-
   Hydrating solutions for cob hydration:
   2.5% solution of glucose (25 g) in 0.45% solution of sodium chloride	isotonic	418	100	77	-	-	77	-
   5% range of glucose in 0.45% range of sodium chloride	hypertonic	837	200	77	-	-	77	-
   0.45% difference to sodium chloride	hypotonic	-	-	77	-	-	77	-
   Zamіsnі roschini (іsoelectrolіtnye):
   5% glucose products (50 g) in lactate Ringer's products	hypertonic	837	200	147	4,0	2	155	28
   lactate (Hartman's) Ringer's	isotonic	-	-	130	4	1	111	28
   10% glucose rosin (100 g) in lactate Ringer rosin	hypertonic	1674	400	147	4	2	155	28
   Ringer's roschin	isotonic	-	-	147	4	2	155	-
   5% Ringer's range of glucose (50 g)	hypertonic	837	200	147	4	2	155	-
   Special solutions:
   5% difference to sodium chloride	hypertonic	-	-	855	-	-	855	-
   0.9% difference to sodium chloride		-	-	154	-	-	154	-
   5% difference to sodium hydrocarbonate	hypertonic	-	-	595		-	-	-
   Deputy ministers of internal affairs
   5% range of glucose (50 g), 0.3% range of calcium chloride (3 g), insulin (10 OD) on Ringer's range	hypertonic	837	200	147	44	2	195	-
   10% range of glucose (100 g), 0.6% range of calcium chloride (6 g), insulin (20 OD)	hypertonic	674	400	-	80	-	80	-
   Roschin Up to 2 HPO 4 (4.5 g), KH 2 PO 4 (1 g), sodium chloride (5.5 g)	isotonic	-	-	94	52	-	94	-

   Substitutes of the internal class are the differences between calcium salts and glucose without sodium, for a small amount of it. The stench stagnates when there is a deficiency of calories, and is especially effective in quiet drops, if sodium is rubbed into the cells to replace calories. Whether it is anoxia, or a change in the metabolism of the spirits, overgrowth of cations, as a result of which there is a depolarization of the cell membrane with the onset of deterioration of the functions of the child's organs. The destruction can be overtaken or smoothed out only by the introduction of the deputies of the inner life.

   Naybіlsh hryatlivya dіya dіya rіzchini nadayut in the period of operative period, normalizing the function of the heart-vascular system, brain, liver, nirok, intestines. The effect is significantly increased when combined with salts of aspartic acid (panangin).

2. solutions for the correction of the BCC deficiency;
   • whole shelter [Show]

     Zapovnennya of the engraved obshyagu with whole blood for the principle of "spewing for specks" has been widespread, but in the rest of the rocky such tactics have been exchanged. When there is a deficiency of the BCC in the form of blood loss, transfusion of whole blood (especially without a preservative) є with the use of a drug. The whole shelter immediately assimilates the deficiency of water, blood cells, electrolytes and erythrocytes, thus saving its specific functions. There is an increase in the number of erythrocytes, the level of hemoglobin, and the amount of blood and normalization of arteriovenous growth in acidity. Especially important is the transfusion of whole blood in case of great blood losses, if anemia is turned to hypoxia and a critical decrease in the buffer capacity of blood.

     Naybilsh effectively direct blood transfusion. Variations therapeutic effect of direct blood transfusion of dressings from the presence of preservatives (sodium citrate) and greater adaptation of the donor's erythrocytes. Direct blood transfusion is indicated in cases of BCC deficiency up to 40-50% or more, a high degree of intoxication, and also, if the infusion of great quantities of canned blood did not give the effect of being safe. However wider sucking The method is interconnected through the technical difficulties in the early days of trauma, there are enough donors at the moment. This is often used for pouring canned shelter.

     In the emergency surgery, blood transfusion is indicated for renewal and normalization of normal blood flow, saving a normalization of transport, and an increase in the number of leukocytes during agranulocytosis and blood loss in the amount of The last few testimonies before blood transfusion are practically dumb, some of them cannot be grounded by data on the biological value of canned blood.

     Moreover, the risik of blood transfusion can be transplanted likuvalny effect... The frequency of slowing down with transfusion of donor blood reaches 10%, and the lethal result, without interfusion with infused blood, is more likely to occur in 0.1-2% of patients (GA Ryabov, 1988).

     The whole roof should be preserved with citrate-glucose (CG) or citrate-phosphate-glucose (CPG) buffer. On the thought of R.D. Miller (1985), erythrocytes and 2,3-diphosphoglycerate (2,3-DPG) are more efficiently stored in CFG-rozchin. In addition, the change in citrate and calcium in the CFH-rose is 20% less than in the CH-buffer; pH of blood, preserved by addition of CFH buffer, per 0.1-0.3 food; ATP level in such blood is also closer to normal. Regardless of the type of preservative maximum term blood loss to become 21 dB. As long as it is not far into the setting of the ideal blood stabilizer, the same type of accelerated and side reactions occur during transfusion of canned blood.

     The addition of a preservative does not mean losing the most important powers of blood. In the world of zberigannya, there is a change in the number of erythrocytes and a warehouse of blood plasma. A shelter was conserved on the vidmina from the native volodya on the basis of a lesser blood-spine. It is not possible to accumulate in some kind of sodium citrate and thrombocyte loss up to the end of 3 days as a result of the establishment of a complex of calcium with blood plasma. On the 9th day, a retraction of fibrin, which is evident in canned blood, is taken into account, so that the possibility of healing the third phase of hemostasis is possible. One hour, the activity of factors V and VIII of the throat of blood decreases. Due to the growth of the term of blood loss, the penetration of the erythrocyte membrane is reduced, as a result of which the calories overwhelm the erythrocytes and the second minute of the loss of sodium. Tse to produce up to accumulation of close to 2 g of vіlnogo kalі in the skin lіtrі blood. Such a change in the transport function of the erythrocytes. Pislya 3 dib sberіgannya Effective transport will be taken care of only by 50% (V.A.Klimansky, 1979). Shelter is preserved, stabilized with sodium citrate and glucose, and even more quickly to reduce hemoglobin dissociation. Tse means that the hemoglobin of canned blood sounds more beautifully and more beautifully. The time of change is already up to the end of the 1st dib, and it reaches a maximum of the 7th dub. Hemotransfusion can lead to the development of anoxia, as in a sick person transfusion of great quantities of canned blood instead of hemoglobin grows from 35 to 55%. The production of sour tissue for such a transfusion goes down, before the shedding of the sick man's shelter was given to the clientele close to 40% of the sour sour thing, and for her - not more than 20%.

     Decrease of spores in hemoglobin of canned blood to sour it will be explained by the fact that in the world of blood cells the level of 2,3-DFG decreases in erythrocytes; zm_st 2,3-DPG in erythrocytes in the world is stored in the storage of hemo-preservative. When the citrate-glucose hemo-preservative TsOLIPK № 76 rіven 2,3-DPG in the erythrocytes decreases sharply by 3-7 dB, and if TsOLIPK № 2 concentration of 2,3-DPG is detected, it will take too much to increase. ... To that, blood transfusion without urahuvannya dii preservative and without correction will obstruct the development of important anoxia. For the prophylaxis of this, it is necessary to normalize the sputtering of cations between plasma and erythrocytes into the blood overflow with a dose of 5.8% sodium chloride on the skin 500 ml of citrate blood (Hemoconservant COL). Roschin sodium chloride normalization zyuzuvannya acid hemoglobin (G.V. Golovin and spivavt., 1975).

     broadcast young people(Viral hepatitis, syphilis, malaria, sleep ailment, SNID) with blood transfusion є one of the most happy... Important reactions and fatal infections are prevented when transfused bacterially obstructed canned blood. A number of gram-negative sticks are good for multiplying at blood temperatures, and after transfusion, an important reaction may develop. It is assumed that, with a daily control, close to 2% of canned blood can be confirmed. The first acquaintance with the information is to repair hemolysis (the appearance of a reddish puff over the siege of erythrocytes). Increase the amount of blood to be buried in the horny color and the age of "lacquer". The toxicity of gram-negative bacteria is tolerated in the presence of hemoglobin in the blood. That is why the patient should be guided by the presence of hemolysis є against the indications before the transfusion of such blood.

     The period for the fall of the transfusion erythrocytes in the earliest minds becomes 34 dB. However, in about 30% of all blood transfusions, especially in ailments, as they often repeat, the experience of erythrocytes is less than 14-16 dB. With bagatorazic infusions of blood, the organisms of the sick person are sensitized and the skin is transfused to a greater reaction of insanity. The frequency of reactions during the first transfusion of blood rises from 0.2 to 0.7%, and with repeated infusions, the rate of growth is 10 times. Intravascular hemolysis, as a rule, occurs ABO-insane and restructuring in 0.2% of all blood transfusions. Often in clinical practice, allergic reactions to blood transfusions are often promoted, which are manifested by urticaria, bloodworm, asthmatic disorders. The swelling of the larynx and important asthmatic attacks develop earlier.

     In 1 liter of canned blood, up to 8800 mmol of citric acid can be found. However, citrate intoxication is caused not by the citrate itself, but by the reaction of the ion with Ca 2+ ion. That is, the symptoms of hypocalceration are overtaken: arterial hypotension, a decrease in the pulse vise, an increase in the distal-distal vise in the slings of the heart and CVP, an increase in the Q-T interval on the EKG. The introduction of great amounts of a preservative can lead to the development of metabolic acidosis, especially in quiet drops, if the metabolism of citrate is impaired in the liver (important liver disease, shock, breast cancer). Immediately after a decrease in pH, the concentration of calories in blood plasma increases. To this, tetanic judgments and asystole can occur. In addition, with the infusion of great quantities of sodium citrate, hypertonic hydration develops with a typical type. Also, for bulk transfusions (5 vials or more), it is necessary to control the volume of Na +, K +, Ca 2+ ions in the blood plasma and the pH value.

     On the thought of G. Gruber (1985), an overgrown skin disease can be injected with 2 liters of blood with no more than 50 ml / min.

     Oskіlki nіtratna іntoksikatsіya in the Danish hour grows in the region, the introduction of drugs in calcium is not recommended. Smell especially not safe for an hour anesthesia with cyclopropane or fluorothane (arrhythmia detection). Razchin calcium chloride (10%) followed by suvorim are shown (signs of hypocalcemia - increasing the interval Q-T or hyperkaliyamii - gostry tooth T). The overwhelming should give rise to the amount of calcium chloride to the fact that it is necessary to replace the calcium in 3 times more, less than 10% of the amount of calcium gluconate. The usual molecular weight for calcium chloride becomes 147, and for calcium gluconate - 448.

     Blood acid was preserved (V. A. Agranenko, N. N. Skachilova, 1986). The pH of the CG-range and the CFG-range should be approximately 5 and 5.5. It is innocent to repair the acidification of canned blood: when the preservative is introduced, the pH drops to 7-6.99. As a result of the metabolism of canned blood, lactic and pyrovic acid accumulates, the number of which up to 21 is added to the old 5 mmol / (L Acidosis of canned blood in the meaning of the world is explained by the high PCO 2, which reaches 20-29.3 kPa (150-220 mm Hg).

     Also, with a skin bottle of blood, a large number of H + ions enter the body of a sick person, which significantly changes the buffer of blood. An alternate blood supply is also increased by the products of the H + ions. Knowing about the negative infusion of acidosis on the myocardium, it is possible to cleanse the development with massive blood transfusions of heart failure. In order to improve the speed of blood flow, the authors recommend introducing intra-intravenously 44.6 mmol sodium hydrocarbonate into the skin 5 ampoules of transfused blood. However, recent developments (R.D. Miller, 1985) have shown that the empirical introduction of sodium hydrocarbonate is very fast. Completely repair the alkalizing therapy for the development of arterial blood CBS (after the transfusion of 5 skin ampoules of blood), if the diagnosis of metabolic acidosis will be established. It is necessary to inject half of the rosrachuncate deficiency of sodium hydrogen carbonate, and then again to control the CBS.

     Over-introduction of sodium hydrocarbonate can be the cause of metabolic alkalosis, hyperosmolarity and negative clinical dehydration. Only in quiet drops, if after the transfusion of canned blood, metabolic acidosis is established (the deficit is more than 7 mmol / l), the introduction of sodium hydrocarbonate is shown.

     Great interest is the improvement in blood viscosity in the world of lower temperature without changes in the hematocrate number. Reduce the temperature of the blood from 38 to 8 ° C to increase the viscosity by 3 times. For the rest of the hour, I recommend before overflowing with a shelter, ale only with a natural path. Shelter, from the refrigerator, is guilty of standing for 30-60 minutes at room temperature. Become the best way to increase the frequency of post-transfusion by 2-3 times.

     In case of blood transfusions of great number of blood, the most frequent manifestations of collapse of the larynx of blood are important thrombocytopenia, as well as deficiency of factors V and VIII (BV Petrovsky, O. K. Gavrilov, Ch.S. Huseynov, 1974). Loss of blood coagulation is possible in any sick person who was transfused for 1 extra 5 liters of canned blood and more.

     Otruunnya kalієm sposterіgaєtsya for the transfusion of the great blood of trivial terms zberіgannya, especially among the ailing people with a decrease in the function of nirok. For the 10th addition, the concentration of calories in the blood plasma increases from 4-5 to 15 mmol / l, and for the 21st, the concentration of calories is 25 mmol / l. The concentration of ammonia in a bottle of fresh blood becomes 12-24 μmol / l. Pislya 21 dib the rate of growth is up to 400-500 μmol / l.

     In ailments with a high volume of amiak in the blood plasma on aphids of the liver, nephritis, or intestinal bleeding, the introduction of 1 bottle of blood of a trivial term of zberigannya can lead to the development of the Komi.

     In canned blood, it is so, like in the capillaries at shots, the plate parts of the unit can be installed. Otzhe, the shelter is not conserved є with a Vibor preparation for replacing the consumed debts. The viscosity of canned blood is significantly increased as a result of the accumulation of erythrocytes. There are two factors that begin to break down microcirculation. Therefore, with an increase in viscosity, the whole canned roof cannot be transfused. The nature of the change in citrate blood before the hour of absorption at temperatures (4 ± 1) ° C is lower than the representations.

     Indicator, μmol / l	1st add	7 dobu	14 dobu	21 dobu	28 dobu
     Blood plasma hemoglobin	0-1,55	3,87	7,75	15,5	23,2
     pH	7	6,85	6,77	6,68	6,65
     glucose	19,4	16,6	13,6	11,6	10,5
     Lactic acid	2,22	7,77	13,3	15,5	16,6
     inorganic phosphates	0,58	1,45	2,13	2,90	3,06
     sodium	150	148	145	142	140
     kaliy	3-4	12	24	32	40
     amiak	21,4	185,6	191,3	485,5	571,2

     Prior to the acceleration of blood transfusion, it is necessary to bring the development of the so-called shock lung. Regardlessly, from the terms of zbergannya, up to 30% of the erythrocytes of the canned blood are found near the viglyad aggregates with a diameter of 40 microns. Drink in the vessel bed, the aggregates settle in the capillary filter of the lungs, increase the dead space of the alveolar bone and significantly increase the arterial-venous shunt on the lungs. Prevention of blood transfusions through special filters.

     Up to 25-30% of transfused donor erythrocytes and blood plasmas are sequestered from circulation and deposited in other organs and tissues.

     Transfusion therapy in patients with hemorrhage is guilty of regaining a deficiency in volume, polypsycosis of capillary blood circulation and oncotic blood plasma detection, transcending intravascular aggregation and education of microthrombi, nadatization of blood clotting deprivation for inclusion The transfusion of donor blood will keep the deficiency obshy; do not expect an renewed microcirculation. That is why the whole donor blood stagnates only in case of massive blood loss before an hour of operations with single blood circulation and in case of bleeding on the most important hemorrhagic syndrome (gostry fibrinoliasis, hemophilia) and generally in plasmatic diseases.

     1. to overcome the deterioration of blood circulation and development of the internal combustion engine. For the whole period of transfusion of 5-10 doses of canned blood, the number of thrombocytes, activation of thromboplastin hour and concentration of fibrinogen is increased. Mati prepare platelet mass. We are sick, since 10 doses of blood have already been poured and it is not necessary to be transfused further, only a roof is needed;
     2. establish a shelter before transfusions;
     3. corystuvat with blood of little terms of the economy and microfilters;
     4. for transfusion of 5 skin ampoules of blood from the start of PaO 2, PaCO 2, pH of arterial or venous blood (for accurate dosage of sodium hydrocarbonate), instead of blood plasma Na +, K +, Ca 2+;
     5. The quest behind the EKG indicators for quick diagnostics of the deterioration of the concentration of calories and calcium in circulating blood.

     Hemolytic transfusion reactions are most often the result of laboratory pardon, incorrect markup or incorrect reading of the label. Mortality in case of important reactions until the current hour of the warehouse is 40-60%. In the minds of the zeniebolyuvannya, hemolysis tends to manifest itself as hypotensive, bleeding or hemoglobinuria. Intravascular hemolysis is the most common deficiency and disseminated intravascular coagulation syndrome. If accelerated has been detected, it is necessary:

     1. pinch blood transfusions;
     2. pіdtrimuvati dіuresis at a level not less than 75-100 ml / year for additional internal transfusion of electrolytes, introduced 12.5-50 g manite. In case of a deficient efect, enter 40 mg of furosemide internally;
     3. Alkalize the cut, bringing the pH up to 8 with an internal introduction of 40-70 mmol sodium hydrocarbonate. Dose the dose only if there is an obvious indication of the pH of the section;
     4. the value of hemoglobin in blood plasma and blood plasma, as well as the number of platelets, activation of thromboplastin hour and concentration of fibrinogen in blood plasma;
     5. transcend arterial hypotension for adequate nirk blood flow;
     6. carry out an external blood transfusion.

     If there are deficiencies in blood elements, it is necessary to inject them, a few inoculations, or it may lead to the development of any pathological manifestations. The deficiency of erythrocytes can be filled with erythrocyte mass, in 1 mm 3 there are close to 10 million erythrocytes. Shown before the birth of erythrocyte mass: chronic anemia without hemodynamic damage (the number of erythrocytes is less than 3 million, hemoglobin is less than 90 g / l, or 6 mmol / l). At the same time, transfusion of vidmitic erythrocytes is shown. Tsey preparation of additions of leuko-, thrombocytopenia and protein antigens, metabolites of blood cells, excess of electrolytes and preservative. The introduction of it is not supervised by the development of immune and pyrogenic reactions. Not less effective transfusion of frozen erythrocytes. Evidence and frostbite erythrocytes are especially indicated, as in the anamnesis of inadequate reactions in case of prior transfusions.

     To replenish the volume of erythrocytes (Pro er) N. I. Davis and D. Cyristopher (1972), the following formula was proponated (the dose for all forms is the same):

     deficit Pro er = O EP1 - (OP x H 2),

     de O EP1 - normal obsyag for a given sick person; OP - normal blood plasma production; H 2 - the hematocrit number in the venous blood at the time of the skinning.

     The transfusion of whole donor blood or erythrocyte mass on aphids and microcirculation (without any leaks) enhances intravascular deseminated coagulation, reduces blood flow from post-mortem tissue. As a result, gross damage to metabolism is developed and changes in mind are created for the loss of the blood cells. To this, transfusion therapy in case of blood loss is guilty of differentiation in the number of cases, intensity, steps, stage of development of hemodynamics and the backward camp of the sick.

     In all types of problems, problems are corrected from the infusion of blood rheological authorities (hemocorrectors). The stench is to lower the viscosity of blood, to increase the z-potential, to disaggregation. Prior to them, rheopolyglucin, gelatin and blood plasma are introduced.

     Dosuvannya can be insured for the formula:

     deficit OP = OK - (OK x N 1) / N 2

     de OP - obsyag blood plasma from hour to day; OK - normal blood plasma exchange for a given patient; H 1 - normal hematocrit number for a given patient; H 2 - hematocrit number at the time of pre-sludge.

     In case of blood loss (up to 12-15 ml / kg), it is possible not to transfuse blood, but to intermittent infusion of rheopolyglucin, or gelatin in an adequate dose in a given dose of physiological sodium chloride / ml in a dose of 8-10 kg. The solution is to create a reserve of interstitial water, to prevent the degradation of cells, to save compensatory reactions to the organism. Infusion of plasma substitutes and rozchiniv electrolytes in the specified doses is shown at prompt engagement ah with the minimum blood loss for the improvement of central and peripheral hemodynamics, as well as the establishment of a good reserve for the treatment of raptus bleeding. If blood loss reaches 16-25 mg / kg, then transfusion of plasma substitutes and donor shelter in children 2: 1. The dose of salt solutions is increased to 15 ml / kg. With a blood loss of 30-35 ml / kg, the increase in blood loss in blood is 1: 1, and with a blood loss of 35 ml / kg, it should be 1: 2. The initial dose of transfusion therapy for blood loss is more severe, the more significant ...

   • blood plasma [Show]

     Native plasma is actually a citrate blood without erythrocytes and is a substitute for plasma. Frozen plasma is prepared with fresh plasmas. First, centrifuge for sedimentation of the form elements, and then cool down at temperatures of -20 and -30 ° С. The frequency of allergic reactions is also the same. Transmission of dry plasmas leads to a trivial saving, a decrease in the possibility of transmission of viral hepatitis and the diagnosis of allergic reactions.

     Albumin becomes close to 60% of all syrovatovyh bіlkіv. Win a colo-osmotic vice and bcc, healthy transport of fats, carbohydrates, pigments and other words to organs and tissues, regulating the concentration of hormones (thyroid glands), steroids ... Albumin can swing amphoteric power. Deficient pH is either acidic or acidic. The albumin molecule is superficially hydrophilic. The vona is soaked with a solid hydrate shell, as it has a higher water solubility, stability and electric charge. Albumin wiklikє plays with a diuretic effect. Circulation in the bloodstream 5-8 add, however, even after 24 years, only 60% of the introduced amount will be lost. Win is a slight disaggregating day and will reduce microcirculation. The introduction of albumin will provide a quick effect in the treatment of hypoproteinemia of any ethology. Razchin albumin is dispensed in 100 ml vials and oncotic activity in 250 ml of plasmas. At 10% of the range, albumin has 132 mmol / l sodium and chlorine, 166 mmol / l glucose and stabilizer. When transfusing albumin, no viral hepatitis transmission has been registered. The blood plasmas that have been added to the above preparations are subdued in the vessel bed and the blood plasma expanding powers. A skin gram of dry albumin is collected in the vessel bed up to the injected volume of 17-18 ml of ridin. Albumin chi will not ruin the transport until quiet times, as long as the hematocrit number does not become less than 0.3. Donor dry and native plasma, albumin and protein stasis for the correction of hypoproteinemia. The required dose of native plasmas (at about 60 g / l bottle) is distributed according to the formula:

     P = 8 x T x D

     de P is the initial dose of native plasmas, ml; T is the weight of the sick person, kg; D - shortage of the backbone bottle, g / l.

     The dose of albumin, which is necessary for the renewal of the normal level in blood plasma, should be started using the formula:

     A = 5 x T x D (a),

     de A is the initial dose of 10% albumin, ml; T is the weight of the sick person, kg; D (a) - albumin deficiency, g / l.

     To rozrakhovanu dose Bazhano should be administered in 2-3 dobi.

     It will remain an hour of growth for the production of new plasma substitutes. The stagnation of piece coloids is tempting in front of the possibility of rejecting them in non-interchangeable numbers and on the outskirts of baguettes, characteristic of blood preparations. It is not possible to name such blood-substituting solutions from the so called blood-substituting solutions, so that through the visibility of the blood cells the stench does not take part in the transport of sour.

     Plasmazamіnnikom is called the difference, which for a day or so normalization of the volume of plasmas involved. Before all blood and plasma cells are visible, such are the vimogi: oncotic, osmotic vice and the viscosity of the guilt are the same as in the blood. The stench is guilty of mothers, it’s the only therapeutic effect, and it’s easy to metabolize and move to the body by such a path, so as not to ruin the functions of the organs in the process of repeated infusions. Rozchini not povinnі Buti toxicity porushuvati hemostasis i koagulyatsіyu krovі, viklikati aglyutinatsіyu, lіzis eritrotsitіv i leykotsitіv, zavazhati viznachennyu group krovі, pereshkodzhati gemopoezu i synthesis bіlkіv, prignіchuvati funktsіyu nirok, zmenshuvati MOS i zbіlshuvati stupіn metabolіchnogo acidosis, sensitize organіzm i viklikati utvorennya antigenіv. Rechovina, which promises all cims to vimogs, do not righteous. All the same, if you become mobile, then even if human blood plasma will be compromised, then there will not be any specific functional functions.

     Bloodsuckers may conceal a number of positive authorities: the potential for the root of great reserves; zberigannya stretching for a trivial hour in zychaynyh minds; transfusion without urahuvannya group belonging to the blood of the sick. Rizik transmissions get sick practically every day. The frequency of pyrogenic and іnsh side reactions built to the minimum.

   • dextran [Show]

     dextran store from high-molecular polysaccharides to starch and glycogen. Yogo otrimuyut as a result of the infusion of dextran-sucrose on sugar-containing products (the enzyme is established in the growing strains of leukonostok bacteria). The number of dextran preparations, which are used in rural areas, are cleverly divided into two groups: dextran-70 and dextran-40. The stench is derived only by the size of the average molecular weight. In our country, polyglucin, identical to dextran-70, and reopolyglyukin, similar to dextran-40; offensive preparations are prepared on the basis of isotonic sodium chloride.

     A colossal osmotic vice and the ability to bite the water to lie in the main form of the average molecular weight of the dextran. The dextran is known to have a molecular weight, it is more concentrated and has a coloid-osmotic vice, the stagnation is not lined. The increase in molecular weight 50 times advances the colo-osmotic vice of all in 2 times. It was established that the internal introduction of 1 g of dextran was increased by 20-25 ml for the preparation of the post-mortem. The results of the experimental and clinical warnings indicate about the fact that the internal administration of dextran-70 and dextran-40 is responsible for the BCC, MOS, the blood pressure, the amplitude of the pulse of the power during the blood flow, The triviality of dextran, which is very effective, lies in the form of a common molecular weight, the amount of the drug introduced and the type of sick person. In patients with hypovolemia, the rate of plasma debridement is reduced significantly more, less with normovolemia. It will be explained by the straining coloid-osmotic to the dextran, which is in the court of the interstitial ridin. One hour dextran pereshkodzhaє swelling clitin, which develops as a result of hypoxia or hypothermia.

     A large proportion of parenterally administered dextran is produced by nirkas, so as a nyrcovy threshold for a newer to become close to 50,000. normal function nirok after 6 years after infusion 30% dextran-70 and 60% dextran-40 will be delivered, and in 24 years - 40 and 70% as appropriate. Douche maliy vіdsotok yogo vivoditsya intestines. The part, which is lost in the organism, the dextran is metabolized in the ovens, selections and nirkakh to oxide in carbon and water and 70 mg / kg for 24 years. Practically after 2 months, all the dextran will increase, and 30% of this is produced in carbon dioxide, a part of which is included in the education of amino acids.

     The penetration of dextran through the capillaries is to be found in the main type of molecular weight. Vin does not pass through the placenta. At extraordinary clinical doses (0.5-1 l / h), the concentration of dextran in blood plasma reaches 5-10 g / l. It is not only because of the molecular weight that lies in the blood plasma. The stench is also amazed by the swiftness of infusion, the sickness and the wicked camp of the ailments (hypo-abo hypervolemia). The concentration of dextran-40 in blood plasma decreases more rapidly, lower than dextran-70, with an equal amount of the introduced dose, which can be explained by the higher penetration of molecules with a low acceptable molecular weight. Molecules with a molecular weight of 14,000-18,000 may be close to 15 min., And after 9 years the infusion of stench will practically increase from the court channel. Dextran will not only not ruin the functions of any other, but it will not only add new products and vivedennya sich. Obviously, the price is tied to the changes in blood flow, to the changes in the survival of the blood flow, which occur as a result of the overgrowth of the blood flow. It has been reported that a slight osmotic dextrose is due to the introduction of dextran-40 to lie not as the dextran itself, but as a salt source. However, 10% of dextran-40 breakdowns are strongly hyperoncotic, therefore, in dehydrated ailments, it is not possible for degraded ailments to be stashed only with an one-hour correction of water-salt rivovagi.

     In case of important hypovolemia (more than 20% blood loss), dextran alone cannot be transfused, as it can help a clinical dehydration. At the same time, the expenditures will be given the same amount of dextran, the same amount of dextran, the same amount of dextran, the same amount of dextran, the same amount of dextran and blood. Absolute contraindications to dextran consumption are organic deficiencies in development of anuria. In cases of prerenal nirkovo deficiency, the introduction of dextran is indicated. We are sick with chronic nircovites only in the extreme range, 6% of the difference to dextran-70 can be used (the amount of water in the water channel is higher).

     The frequency of allergic reactions to infusion drugs in dextran has changed dramatically over the past few hours. In even worse cases, there are urticaria visceral and increased temperature. It was brought, that in the grass channel people є microorganisms, which produce dextran. In addition, it is necessary to enter the warehouse of young fabrics and business bills. To that, the introduction of dextran, which is obtained from zukru for the help of other strains of bacteria, can lead to reactions for the type of antigen - antigen.

     The aggregation of forms of blood elements accelerate when the concentration of proteins (globulin, fibrinogen) in the blood plasma increases, for example, of proteins with high molecular weight. The increase in the size of the agglutination results in a uniform building of the cytrocytes before the aggregation (OCEA). Normal human plasma OSEA has a doorway of 1 mm / l. For dextran with a molecular weight of up to 50,000 won, the cost is 0. With an increase in molecular weight, OCEA dextran grows rapidly. So, with a specific molecular weight of 100,000 won, the cost is 10 mm / g, and the value for fibrinogen is 17 mm / l; This means that, in the context of fibrinogen, the aggregation of forms of blood elements is 17 times faster than in native plasma. Dextran with an even higher molecular weight (more than 150,000) can cause intravascular blood aggregation. At the same hour, the preparations with a tolerable molecular weight of 40,000 and lower do not increase the fluidity of agglutination. This is an important practical application: in case of shots and in those who are suffering from microcirculation, dextran preparation with a molecular mass for 40,000 will not be used. It has also been reported that the viscosity of the blood after the introduction of dextran-40 will change, and after the introduction of dextran-70, it will change. To that, the microcirculation is infused only with the infusion of dextran-40 (reopolyglyukin).

     Dextran-70 in clinical doses slightly podvzhu the longest hour of blood larynx, the appearance of active thrombocyte factors. Dextran-40 in a dose up to 2 g / kg does not affect any kind of infusion on the blood circulation mechanisms. However, rheopolyglyukin at a concentration of 20 mg / ml of blood podovzhuyu hour of approval of fibrin and retraction (V.S.Savel'ev and spivavt., 1974). The frequency of bleeding due to surgeries due to unit extracirculation and perfusion to dextran-40 decreased from 7.5 to 3.6%. At the same hour, with a trivial perfusion of 90 minutes, bleeding increases (V. Shmitt, 1985). With hypothermia, the introduction of dextran-40 increases fibrinolytic activity.

     We find the power of rheopolyglyukin є th anti-thrombotic effect. Storing blood loss from an hour of surgery with blood and dextran in a period of 1: 1 reduction of the frequency of surgical thrombosis and thromboembolism by 5 times. According to G. Rikker (1987), antithrombotic effects are the same as when small doses of heparin are administered to children. The mechanism of this effect is explained by hemodilution, the strengthening of venous blood flow, especially in the glib veins of the lower edges, the improvement of blood flow, as well as in the middle of the process of burning blood from fibrin. It was established that the lysis of blood clots was sent to the dextran for infusion. Vin protects in parallel with the weakening of platelet adhesiveness. The offense processes reach the maximum in a few years, since the dextran in the blood will also become a founding one. Imovirno, dextran temporarily changes the structure and function of factor VIII blood larynx.

     The introduction of small quantities of albumin, which is the same as dextran coloid-osmotic effect, does not prevent the development of thrombosis. For the prevention and treatment of thrombosis and thromboembolic acceleration, the following dosage is recommended: 10-20 ml of rheopolyglucin per 1 kg of mass internally for 4-6 years in 1 to half of the symptoms of all the onset days before the recurrent disease.

     Reopolyglucin will significantly reduce myocardial infarction, endocardial infarction, thrombosis of cerebral and brijovic vessels, as well as frostbite and opicions. Absolute indications to the stasis of rheopolyglyukin are shock, sepsis, embolism, as well as those of the state with damaged microcirculation (deficiency, piece blood circulation, the introduction of high doses of X-ray contrast speeches).

   • gelatin [Show]

     There are three types of gelatin types that can be stored in the clinic. The stench is perceived by the original material and the way of preparing it, but it is the same for me molecular weight... Preparations are stored in a mix of even small and even of great molecules, so only average molecular weight is needed. A useful material for rejecting gelatin є skin, tendon and cist of great horny thinness. Otriman gelatin (6% of the range) is given for additional chemistry and physical processing until the end products are approved with an acceptable molecular weight of close to 35,000. In our country, gelatinol is produced - 8% of the varieties of grub gelatin from an average molecular weight of 20,000 ± 5,000; the coloid-osmotic vice should become 1.96-2.35 kPa (20-24 cm of water column).

     Approximately half of the internally introduced gelatin is added to the 1st dobu. After the introduction of 500 ml of gelatin, the concentration in the blood plasma becomes 7.8 g / l, after 6 years, the level is 20-25%, and after 24 years it will only start. Little is known about the metabolism of gelatin in the body. With trivial parenteral administration of gelatin with a variety of amino acids, after 72 years, an insignificant amount of disintegrated gelatin appears. To that, the consumption of drugs for parenteral feeding is not enough for the senses. Moreover, є now about galvanized injecting gelatin for the synthesis of bilks. Preparation of gelatin may be good for zbilshuvati diures (L.G.Bogomolova, T.V. Znamenska, 1975).

     Gelatin, as and all of the other protein preparations, can be similar to the antigen, can be tested for the preparation of gelatin antibodies. To that end, if there is infusion of gelatin (in 10% of vypadki), there may be a reaction to the antigen - antigen. The stench is clinically manifested by exanthema, blistering, hyperesthesia, acrocyanosis, conjunctival arteries, tediousness, coughs, coughs, squeezing pain in the breasts, feeling the temperament of unbearable, unbearable The symptoms are supplemented by the swirling aggregation of the forms of blood elements. If you pour the preparation into dextran and gelatin on the steps of the aggregation of erythrocytes and thrombocytes, then it will appear that the aggregation is repaired with the total molecular weight of 59,000, and so for the gelatinous mass of 18,000 000 accelerating the reaction of the adoption of "coin stores" so itself, like dextran with an acceptable molecular weight of 75,000.

     All gelatin preparations significantly increase the viscosity of the blood, and the very fact that it stagnates in the capacity of the coagulant. When microcirculation is damaged, it is necessary to reduce the amount of blood that was consumed by blood plasmas with the help of gelatin in a clean view. Use dextran-40 more colorfully in a ratio of 1: 1. Use pseudo-agglutinating gelatin to wipe out pseudo-agglutinating gelatin, as you can speed up the appearance of a group blood. The antithrombotic effect of gelatin is small and similar to such dextran-70. Vono was poured over by deyakim podvizhennyam hour of bleeding and throat throat, as well as hemodilution. Ale all zastosovuvani at once preparations of gelatin volodyut mensh circulate with an overall effect, lower shelter, plasma or dextran. Adjustment of the BCC for the infusion of gelatine growths in the first year due to the introduction of this amount (E.S. Uvarov, V.N. Nefedov, 1973).

     The results of the treatment of shock by the size of gelatine are few and far from quiet, if the volume of blood is consumed by the amount of salt.

   • polyvinylpyrolidone [Show]

     Rechovina synthetic prokhodzhennya, є polymer vinilpirrolidone. The results of the development of polyvinylpyrolidone in experiments and clinics give a streaky set before the last (L.V. Usenko, L.N. It has been established that all preparations with an admissible molecular weight of up to 25,000 and more often accumulate in the reticulo-endothelial system and not be carried out from a cross-section of many rocks (L. A. Sadova, 1973). The share of cich particles of nevidoma is higher. Danih about those that the stink is metabolized in the body, while it is still. Children of the past are involved in the consumption of drugs in polyvinylpyrolidone with a molecular weight of close to 40,000, phagocytic activity changes.

     Vіtchiznyana promiscuity vipuskaє drug hemodesis from the average weight of molecular weight 12 600 ± 2700, colo-osmotic vise 6.57 kPa (67 cm of water. Art.) I pH is close to 6. For additional radioactive methods, the degree of hemodez was definitely reassigned. It has been established that it is innocuous for the faction to overshadow the circulation, and that it does not seem to be a common defect. Polyvinylpyrolidone (18% of the razchin) appeared in the section until the end of the introduction; after 3 years, 48.3% eliminuvati, and after 6 years the drug will be added to the ship's channel. Hemodesis viklikє mild diuretic effect. A little bit of a problem is developing in allergic reactions and schilosity up to hypotension with repeated introductions.

     The main indications before the stagnation of hemodesis intoxication of the developmental genesis of concomitant microcirculatory disorders, which are summarized by the high fraction of polyvinylpyrolidone in the form of toxic products of rosé. However, the power of the polyvinylpirolidon is recognized by the foreigners. With the help of care, one-time slid inject no more than 1000 ml of hemodez. Investigation of blood care must be taken only after life is shown. To achieve the detoxification effect, it is enough to introduce 5-15 ml / kg of hemodesis for children and 30-35 ml / kg for adults. Repeated infusion is possible after 12 years in the same dose.

   • starch [Show]

     Zastosuvannya hydroxylethyl starch as a bloodsucker, primed with a therapeutic effect, even close to that of dextran. Win is not a vicious antigenic and toxic action and does not interfere with the processes of blood larynx. It can be taken from the grains of bread and rice, the usual molecular weight is up to 100,000.

     The first results of clinical viprobuvan will show sufficient efficiency and good tolerance of infusions. However, the process of spreading the starch has not yet been introduced, the time-consuming phenomenon of accumulation does not occur, and the pathophysiological mechanism of intolerance to the problems of the little ones is not included. Do not go to the prevention of such reactions.

3. products for parenteral feeding

   PIECE enteral
   I PARENTERAL KHARCHUVANNYA

Energy efficiency of speech exchange, as well as functional building of vital systems and parenchymal organs (liver, legends, nyrcs), so that metabolism is prevented, playing a special role in the situation. The shortage of food is even more important, some of them can lead to the destruction of the processes of healing wounds, the development of non-destructive growths, the activation of the reduction of the organisms of the synthesis of the blood-borne reaction

Razr_znyayut decilka types of piece food: enteral, parenteral, combined.

enteral feeding

Enteral food is close to natural and it can be signified at the time of the day.

In the forefront, it is necessary to change the intestinal passage (peristalsis) and reconsider the intestinal health due to the addition of d-xylase. Tsei zukor actively soak only in the small intestine, it is practically not metabolized into organisms and vivoditsya through the section. When I receive 5 g of the drug in 2 years, I see not less than 1.2-1.4 m Excretion mensh 0.7-0.9 g injected into the intestines.

Harchuvannya is a component of therapy. If the sick person has an important deterioration of the water, acid-base and electrolyte balance, then it goes to coriguvati in the first place.

It is still a matter of course for the exchange of speeches and for the amount of money and energy value of the economy. It is necessary to follow them, since the race included a sufficient number of indispensable officials - amino acids and fats. Table 1. the additional requirements for energy materials, amino acids and calories in the period of operation during enteral feeding are given (according to W. Abbott, 1975) [Show] .

Table 1. Additional requirements in energy materials, amino acid and calcium in the period of operation during enteral feeding (according to W. Abbott, 1975)

In addition, in the race include 150-250 g of simple carbohydrates. Prior to the appointment of the designated storehouse, it is necessary to carry out the correction of the water-salt solution and KOS with a parenteral route. In 1 dobu, inject half of the rosrakhunkovo ​​dose.

Doslidzhennya F.G. Lang and Spіvavtorіv (1975), W. Abbott (1985) made changes for the preparation of the so-called elements of the day. Stink is a sum of synthetic essential amino acids and fatty acids, simple carbohydrates, electrolytes, microelements and vitamins. Dose of warehouse Ingredients for such a layout, so that you will not be able to balance your child's life and energy efficiency. Smell vypuskayut in powder-like or granular form, the stench is good at water and may have a neutral relish, do not over-etch and get wet, as a rule, without excess. In such a rank, the sign of the elementary days of the re-equipping of the grass channel, the migration of microflora and flatulence.

In an hour beyond the cordon, there were zasosuvannya kilka elemental dies ("Complan", "Biosorbi", "Vivasorb"). Yak butt guided chemistry warehouse sumіshі "Complan". You can take advantage of the balanced number of drinks, carbohydrates and fats, as well as the necessary vitamins and salts. Sumіsh є zhovtuvaty powder, easily disassembled in water, or in any kind of distributor (milk), it is taken for gusto, take away a small amount of fat, a small amount of fat, a grain of wheat and a grain of wheat, which is good to be tolerated by a sick person (4508 g) [Show] .

The usual dose of the sum for bedridden ailments ranges from 112 to 450 g. The dilution from the water can be either vipit or introduced through the probe, either drip or jet.

zondove kharchuvannyaє a type of piece enteral feeding. Vono transmission of the introduction of ridin and living problems through the nasogastric, nasoduodenal, nasojejunal polyurethane probes, as well as through the esophago-, gastro-abdominal jejunostomy without interruption (kraplinny) or fractional method.

• showing [Show] .
  • coma,
  • slit-facial trauma,
  • obstructive ear of the pharynx and stravohode,
  • I will become with an increase in metabolism (symptoms, sepsis, polytrauma),
  • I will begin to perform operations on the head and head,
  • as an additional parenteral feeding, especially in the period when ailments are transferred to enteral feeding.
• Prototype indications: intestinal obstruction, unbroken vomit, proximal intestinal fistula with swollen secretion.
• Carrying out rules [Show] .

  Rules for carrying out probe feeding

  Intermittent drip method: install the probe at the same time as it was introduced; dilute the product, which is injected to a concentration of 2.1 kJ / ml; increase the rate of administration not more than 50 ml / year in older adults and less than in children; Reinsert excess skin for 6 years (if the amount is 100 ml, an interruption of 1 hour is required); if there is a lack of glucosuria, diarrhea, hyperglycemia, unacceptable sub-active indications and a small amount of surplus, not more than 100 ml, it is possible to increase the amount of the introduced dose at 25 ml / year; When the amount of money is introduced, when it comes to energy needs, the energy cost can be introduced for 1/4 of the skin for 24 years.

  Fractional method: on the 1st day through the skin 2 hours inject 1 portion 30-45 min; on the 2nd day, after 3 hours, inject 1 portion of shvidkistu 45-60 min; zb_lshuvati interval between introduced until quiet feast, as long as the ailments cannot be consumed 4-5 portions per day; The amount of the introduction is not to blame for the change of 10 ml / l, and the amount of surplus before the introduction is guilty of being less than 100 ml.

• obov'yazkovy mind [Show] .

  Obov'yazkovі drain for the probe feeding:

  1. routine control of oil;
  2. precise control of the energy balance and number of bins with urinary damage to the skin 8 years;
  3. control of the position of the probe before the skin lesion, or after 6 hours with the non-interruption method;
  4. The value of the concentration of glucose and nitrogenous slags in the skin section is 8 years old, until the time of day is not stable.
  5. repairing the year with flatulence and diareia;
  6. retail laboratory control;
  7. daily retreat look and sanation of mouth emptying, nasal passages, gastro-abnormal jejunostomy;
  8. mode of maximum mobility activity.
• Warehouse of sums for probe harvesting [Show] .

  As a matter of fact, it’s because of the mother’s high energy value and supply of plastic materials for a reasonably small society. Warehouse of solutions for introduction into the small intestine as much as possible close to the warehouse with chemus. M. M. Baklikova and author (1976) to smell 3 sums for probe feeding (Table 2).

  Table 2. Warehouse of sums for probe harvesting
  Ingredієnti sumіshі	Kіlkіsny warehouse of Ingredієntіv sumіshі, g
  	Sumish N 1	Sumish N 2	Sumish N 3
  My meat broth	500	1000	2000
  meat vidvarne	-	200	400
  Vershkov oil	50	50	50
  Egg (zhovtok)	36	100	100
  sour cream	100	100	100
  Morkvyaniy sik	200	200	100
  Apple juice	200	200	100
  dried apricots	150	100	100
  oatmeal	30	30	30
  Manna groats	-	-	40
  Kartoplya	-	-	200

  The sum is recommended for the probe feeding for 5-6 days during the operative engagement on the grass channel. Leathers from the options for the living sums are stored in portions A and B, as they are stored ok in the refrigerator and to change before the implantation. Portia B to take away from dried apricots, carrots and apple juices. Rozrakhunkova add some water and salts before implantation. Inject 400-500 ml of sum through the probe 3-4 times a day. In addition, 1 time in 3 days before the storage of the sum, include 5-10 mg of Nerobol.

  In the Danish hour for the enteral, including the probe, the feeding of the industrial production is balanced at the chemistry warehouse for easy food consumption (1 ml of the sum is 6,3-8,4 kJ, or 1,5-2 kcal). Most of them in total 1500-3000 ml living talk, Vitamin and salts.

  1. cooked from milk, wines, eggs, broth and vegetable juices with additional supplemented products (meat, riba, sir);
  2. z products of a childish food ("Baby", "Malyuk", "Health" and ін.);
  3. ізні sumіshі for enteral feeding (bіlkovі, zezhirenі, lactose-free and in.);
  4. canned sum of industrial food production from natural products (meat-vegetables, meat-cereals, milk-cereals, milk-fruits, fruit-vegetables);
  5. promises of "high-quality" sums based on bols, fats, and carbohydrates from roselin ("Naga-Sonda", "Ensure", "Traumacal" and other);
  6. "Element" children are made from the sum of synthetic amino acids, simple candies, vitamins, minerals with low fat content ("Vivonex", "Flexical", "Vivasorb" and in.).
• [Show] .

  Folding enteral (tube) feeding

  1. Aspiracy pneumonia.

     prevention:

     1. continuously increasing the head end of the lid by 30 ° in the case of the non-intermittent dribbling method and not less than 1 hour during the session of the fractional harvesting;
     2. over the interruption-free method;
     3. control over the growth of the probe and the amount of surplus in the place of the skin 6 years;
     4. installation of the probe behind the gate.
  2. Diarrhea.

     prevention:

     1. zasosuvannya without interruption method;
     2. vikorystannya products, scho not to revenge lactose;
     3. the breeding of the living sums.
  3. Dehydration (secondary) through the introduction of concentrated solutions.

     Prophylaxis: prior to the outright scrapping of the sum of 50% of the water, do not enter it with any other way.

  4. Metabolic products.

     Prevention: retail clinical and laboratory control.

  5. Folding, tying with the introduced probe (trauma) or trivializing it in the grass canal (bedsores).

     Prevention: cleaning thermoplastic polyurethane probes.

parenteral feeding

showing [Show] .

• a waste of more than 10% of the oil before and after the operation period;
• unwillingness to accept more than 5 days and more (numerical diagnostics, intestinal obstruction, peritonitis, important infection);
• trivial ShVL;
• necrotic enterocolitis, deterioration of etching and wetting of the disease, as well as obstructing the life of pathology in premature and newborn children;
• congenital defect development (intestinal atresia, tracheopathic fistula, etc.);
• short bowel syndrome;
• the need for functional expansion of the intestine when state of pancreatitis, Intestinal fistulas, secretory diarrhea;
• obstructive ear of the intestinal tube, which is transformed into enteral feeding; important injuriesі optics, rapidly increase the metabolic consumption or reduce the amount of enteral consumption;
• exchange of any chemotherapy in oncological practice, if the enteral feeding is unhealthy;
• deyakі fired up the intestinal tube;
• swirling colitis, Crohn's ailment and іn.;
• I will become comatose;
• neurological pathology (pseudobulbar parallel and in.), if parenteral feeding we will dance with the probe.

• shvidko the loss of oil> 10% has come;
• change of albumin in blood is less than 35 g / l;
• The thickness of the ridge fold in the area of ​​the trigolovy shoulder is less than 10 mm in choloviks and less than 13 mm in females;
• the circumference of the middle of the shoulder is less than 23 cm in cholovikiv and less than 22 cm in females;
• the number of lymphocytes in the blood is less than 1.2-10 9 / l;
• Decrease in the index of creatine.

Before the ear of parenteral feeding, it is necessary to put down such factors, such as bile, hypovolemia, vasoconstriction, traumatic shock, overwhelming temperature.

The main meta of parenteral nutrition is the prevention of plastic needs for the body, a reduction in the drop of cells in cells, as well as compensation for the energetic and water-electrolyte balance. Even though the price is not reached, the organism of the vicarist has its own reserves: glucose, glucogen, fat, blood; with a lot of ailments I have been involved in masi. At the same time, 10 g of nitrogen is added to the mixture in 60 g of bottles, which are replaced in 250 g of the mixture. Especially great losses during great operations.

Energy demand is widely varied among children with ailments. Rise to the maximum, middle and minimum energy demand:

For calm, 1 kg of mass requires 105-126 kJ (25-30 kcal), including 1 g / day of a bottle. As a result, the accelerated exchange of words in case of feverishness, stressful situations, or when the operation is going to increase the demand for energy. Increase the temperature by 1 ° C to increase the increase in energy by 10%. Minimal energy demand for a sick person with a weight of 70 kg during the operating period of the warehouse is 7531 kJ (1800 kcal) (Yu.P. Butylina and spivavt., 1968; V.P. Smolnikov, A.V. Sudzhyan, 1970; V.D . Bratus і spіvavt., 1973).

For parenteral feeding

• in carbohydrates (1 g in carbohydrates-18 kJ),
• bottles (1 g bottle - 17 kJ),
• fat (1 g fat - 38 kJ)
• polishirti.

It cannot be introduced internally in a dry viglyad from the same rivers. Otzhe, a necessary singing minimum of a child for their decision.

With the planned therapy, there are three interconnected factors: the minimum need of the sick in the family and the electrolytes, the maximum tolerance to birth, the need for energy and the early life of the child.

It is even more important to take care of the need for energy, as it should be done, so that the blood circulation is introduced. At the same hour, I see that it’s satisfying to consume in the energy quickly to the maximum tolerance. The minimum requirement in water is to start with an effective excretion of toxic products with nirkami and a minimum amount, in which case it is possible to introduce a special speech. The maximum tolerance is the beginning of the maximum nirkovo rykretsіyu and building nirok I cut. Naybіlsh rationally appropriate 150 ml of water on the skin 418 kJ (100 kcal) of the main exchange (VD Bratus і spіvavt., 1973). The quantity in children with ailments increases in fallowness due to homeostasis.

Carbohydrate in parenteral

In a carbohydrate є dzherelom "great" energy, the stench takes an unbeatable part in the industrial exchange of words, in advance of the development of hypoglycemia, ketosis, leads to a deficiency of glycogen, and delivers the energy directly to the oven. On the contrary, the stench doesn’t make up for surplus products, which require nirki. Highly concentrated products of glucose may be diuretic.

For parenteral feeding, vikoristovuyt rozchini glucose, fructose, sorbitol, xylitol, ethyl alcohol. The stench may seem to grow in value and guilt. Fructose is metabolized in the liver, adipose tissue, and in the mucous membrane of the intestine. Transformation її doesn’t change to those, if in failure of glucose exchange. Fructose is transformed into glucogen shvidshe, lower glucose. With a strengthened vikidi glucocorticoids in the period of the operative period, tolerance to fructose is saved, and to glucose, navpaki, is reduced. Fructose is very strong, low glucose, antiketogenic effect. You can get stashed without insulin. The exchange of glucose is consumed in our organs, but there is an especially great need for the brain and the brain. To this, glucose is indicated for the prevention of energy muscles and the brain, and fructose - for liver damage, ketoacidosis and during the period of operation. In the classroom practice, it is necessary to consume 5%, 10% and 20% of the range of fructose and glucose. Higher high concentrations (30-40%) can provoke development of thrombophlebitis and porous exchange of water (dehydration in case of osmotic duresis). The frequency of thrombophlebitis decreases when there are infusions of high concentrations in the central vein. Glucose in a bottle of 10 g burns for 1 hour. Insulin acceleration process. Fructose can be injected with trocha shvidshe, lower glucose.

Xylit and sorbitol is transported, metabolized without insulin or antiketogenic effect. Xylit is transformed into glucuronic acid, which is especially indicated in case of liver damage. Sorbitol is split to fructose. Win maє zhovchoginu, sechoginnu and stimulate peristalsis in my life, and also reduce the rheological power of blood. Negative moment є movement of vision with nirkami, as well as the appearance of metabolic acidosis (A.P. Zilber, 1986).

Ethyl alcohol zberigaє bіlki and fat to the body, diє yak in carbohydrates, quickly delivering the necessary energy (1 g of 96% ethyl alcohol will give 29.7 kJ, or 7.1 kcal). Stagnation of ethyl alcohol is not indicated in case of loss of liver disease and deterioration. Winning bronchoconstriction does not occur and in some cases it is not possible to develop bronchospasm. Ethyl alcohol cannot be substituted in carbohydrates, and its introduction is permissible in doses that do not affect the reaction. Infusion to alcohol can be carried out in combination with amino acids and carbohydrates (P. Varga, 1983). The toxic concentration of alcohol in the blood becomes 1.0-1.5 ‰, the boundary permissible concentration is 5 ‰. Schob uniknuti іntoksikatsії zagalnaya dose introduced for 1 add alcohol is not guilty of changing 1 g / kg with 5% injection of 5% range of 17-20 ml / year.

Bilkas in parenteral

Povnotsinne parenteral feeding cannot be done without prescribing only the differences in the tsukriv. Obov'yazkovo guilty, but it is covered by all the needs in bilkas. In the molecule of a protein 23 amino acids are identified with the protein molecules of human tissues. Smells are born on irreplaceable and replaceable. The ideal amino acid sum is to replace adequate quantities of substituted and essential amino acids. Below is the minimal need for the growth of people in essential amino acids.

Introduction amіnokislotnih rozchinіv for vіdshkoduvannya defіtsitu bіlkіv shown at peritonіtі, vazhkіy krovovtratі, poshkodzhennі tkanin, neprohіdnostі bowel pnevmonії, empієmі, trivalomu drenuvannі wounds i porozhnin, astsitі, vazhkіy formі dispepsії, enteritі, virazkovy kolіt, menіngіtі that іnshih vazhkih GOSTR zahvoryuvannyah.

Common contraindications are heart decompensation, pechinkov and nirkov deficiency, especially supervised overdose of nitrogen, decompensation of metabolic acidosis.

Blood, plasma, blood, blood, albumin and protein are not enough for parenteral feeding. If you want to take refuge in blood close to 180 g / l bottle (30 g blood plasma and 150 g blood hemoglobin), it’s not very effective for parenteral feeding; a necessary complex of amino acids, which enter into the processes of synthesis. In addition, the amino acid isoleucine is indispensable in hemoglobin throughout the day. Blood plasma fractions are also rich in isoleucine and tryptophan, and the period is even longer (globulin - 10 days, albumin - 26 days).

Significance of transfused blood, plasmas and albuminous albumen in cases of induced deficiency: in case of blood loss - transfusion of blood, in case of non-fatty albumen - plasma, in case of albumin deficiency - introduction of syrovatous albumin.

At the norm, the requirement in the bottle is 1 g / kg. It is easy to move among seriously ill people (V. Shmitt і spіvavt., 1985).

In clinical practice, to achieve a wide expansion of nabuli hydrochloric acid (hydrolyzate to casein, hydrolysin and aminocrovin). In case of infusion, the following rule is followed: what is more rapidity of the introduction of a hydrochloric acid, the less it takes. The amount of infusion is not guilty of changing 2 ml / hv. Then gradually increase up to 10-15 ml / min. We draw out the ailment because of the pechinka lack of bile, it is necessary to transfuse more often. In case of a narrow deficit of a bottle for 1 extra, you can enter 2 liters of alcoholic hydrolysis.

The best material for children to use guides is to serve case and meat drinks. The main part of the process of processing polygonal preparations is in the fact that the stench vibrates from natural live products from the physiological warehouse of amino acids. At the same hour, when the proteins are split to amino acids, do not expect to undergo excessive hydrolysis: fragments of protein molecules will be lost in the breakdown, as it is not only not vicious in the quality of the living authorities, albeit with the toxicity of youth. The stench itself is indicative of the alarmingly high rate of allergic reactions due to infusion (especially repeated) preparations in hydrolysis of casein.

The range of amino acids is the most potent solution for parenteral feeding. The stench is absolutely apirogenic and stable. Warehouse of the amount of amino acids can be changed due to the nature of the disease and deficiency of this amino acid. In the ideal case, the blame is due to all essential amino acids, as well as a small amount of nitrogen, from which organism is self-contained can be found in the amino acid. Prototypes are shown before the consumption of amino acids is found; there is a lack of deficiency in the replacement of surplus nitrogen, which is important for the reduction of the liver. Dobova dose is 1-1.5 g / kg, with advanced catabolism - 1.5-2 g / kg. Minimal dobova need - 0.5 g / kg. The speed of the internal introduction is not to blame for the change of 2 ml / kg in 1 hour for a grown-up person. Increase the amount of liquidity to produce up to the added loss of amino acids from the cross-section. Pobichna diya in viglyadі tediousness or blues, spontaneously grow in the edge.

At the skin level of amino acids, there are products that are necessary for vitrate energy synthesis for the synthesis of protein, and electricity. For the metabolism of 1 g of nitrogen, 502-837 kJ (120-200 kcal) is required; Glucose is not needed for food, so as you can fix with amino acids before the hour of sterilization of toxic products, so that it would be more difficult for them to be reinterpreted. In a given hour, 5% isotonic dose of aminosol (732 kJ, about 175 kcal), 5% hypertonic range of aminosol on sorbitol (1443.5 kJ, or 345 kcal), 5% isotonic amount of aminosol (about 345 kcal) ). The ratios are set to 10 mmol / L sodium and 17 mmol / L calories. Polyamin, a viable preparation, which reveals 13 amino acids and sorbitol, is easily absorbed by the body. Win revenge 145 mg of tryptophan in 100 ml. Dobova dose of polyamin from 400 to 1200 ml / add.

One hour with the protein preparations should be introduced into the carbohydrate donators of energy. In the first place, amino acids are vitrized during the process of dissimilation. The order of the tsim docіlno dodatkovе introduction of a balanced number of electrolytes. Especially significant is small, as it takes an active part in the process of synthesis of the wine. Parallel to the sign of anabolic steroids, vitamins of group B (B1 - 60 mg, B6 - 50 mg, B 12 100 mg) accelerates the normalization of the damaged nitrogen balance (G.M. Glants, R.A. Krivoruchko, 1983).

Fat in parenteral

Fat with success in the parenteral parenteral vigorous energy value: 1 liter of 10% fat emulsion should be close to 5.230 kJ (1.23 kcal). Fat is transported with lipoproteins and glaze with blood by the liver (mainly), reticulo-endothelial system, lungs, spleen and cystic marrow.

Pechinka and legends are mainly added in the process of re-making fat. In the last few days of breaking down the method, transfer fat emulsions well, as a good material for those who are bavovians, soy beans and sesame oils. The oils (triglycerides) are stabilized by 1-2 emulsifiers.

Shown up to victorian fat є parenteral feeding, which is carried out for a trivial hour, and especially those drops, if it is necessary to interfere with birth, - nirkova lack, anuria. Prior to special indications, it is necessary to consume the appetite, frying with barbiturates, vaginism, perechastny curtains, as well as parenteral feeding of new-born women.

Prototype indications: shock, loss of fat metabolism (hypertension, nephrotic syndrome), fatty hemorrhage, hemorrhagic diseases, pancreatitis, severe liver damage, comatose stanum (short uterine conditions), atherosclerosis

Dose: 1-2 g of fat per 1 kg of skin oil 24 years. With a weight of 70 kg, 100 g of fat is required (2 bottles of 10% lipofundin). Drinking 10-15 vials of lipofundin, or it is necessary to interrupt it for 2-3 days, and to carry out laboratory control of a number of functional and morphological indicators of liver and blood (hypoplasm of blood, appearance of the foot) Recommended rate of infusion. The amount of shvidk_st become 5 dribbles / s, dal by stretching the first 10 s wona grow up to 30 dribbles, and with good tolerance it can reach 5-8 g / year. At a high rate of infusion of fatty emulsions (more than 20-30 drops per 1 hour) bitter appearances The inter-tolerance will break down, due to which the speech is introduced in the part of the population. Above all, fat emulsions were added to the range of amino acids and heparin was added (5000 OD per skin bottle of lipofundin). Fat is stored in the refrigerator at a temperature of 4 ° C, and before infusion, it is heated to room temperature. Oh, it’s not possible to get rid of it, because it’s easy to attack demulgizatsiya with further side effects. Pislya infusions intralipidu mi inodi sposterigali small advices fever, chills, chills and blues (no response). The loss of reaction to the introduction of fat (Overluding syndrome) grows in the edge of the small and small in the liver, so that it is superfluous, if not, it increases the bromo-sulfalein test, decreases the level of prothrombocyte. Anemia, leukopenia, thrombocytopenia, bleeding are immediately apparent. With the additional dosage and quickness of the introduction of the malignant fever, it is possible to overcome it.

According to Harrison (1983), infusion of fatty emulsions to reduce the diffusion rate of legends and reduce PaO2. A description of the prevention of fat accumulation in the lungs of premature babies, which was taken away from the overwhelming doses of lipids, led to the deterioration of ventilation-perfusion disorders and the development of mental deficiency. Already, the sign of lipids and other components of parenteral feeding is seriously ill with signs of dysfunctional deficiencies, and we are healthy in the region carefully, given the clinical laboratory control.

For a sick skin, create an individual infusion plan, which will transfer the offensive rules:

1. The speed of the introduced glucose is not to blame for the change in the rate of utilization in the body - not more than 0.5 g / (kg · year);
2. the sum of amino acids and hydrolysis needs to be injected immediately through the spouts, so that energy is not supplied for their absorption (1 g of nitrogen is injected into 800 kJ, or 3349 kcal of energy);
3. the dose of waterborne vitamins is guilty of 2 times and overwhelms the need for them; in case of trivial parenteral malnutrition, it is necessary to inject і fatty tissue vitamins;
4. deficiency in microelements liquidate transfusions of blood plasma 2-3 times per week and blood (zalizo); the need for phosphorus (30-60 mmol / add) with a range of KH 2 RO 2 (M. V. Danilenko and spivavt., 1984).

It is recommended to combine amino acids with concentrated varieties of sugar and necessary electrolytes. In special vipadki add fat emulsions. To ensure the inclusion of amino acids in the synthesis of a protein, a sufficient boost of energy is required. More precisely, the dosage of infusions at one hour is especially important for new-born women, as well as with the introduction of potent speeches. For the establishment of the necessary frequency, the dribble can be added, but 15-20 drops can be added to 1 ml.

Parenteral feeding є with an obvious folding approach, so as with a whole organism it is free to regulate power. With the first time, however, you need to want to get a little bit of an enteral route. It is especially true in ailments with craniocerebral trauma, numerous maladies, right, for which energy needs cannot be covered by parenteral food alone.

These types of products are combined enteral and parenteral to ensure the need for food, normal energy and water-salt balance.

Infusion therapy of forced duresis of important opic shock

.Infusion therapy is a whole method of treatment, recording on the intrinsically introduced intravenous, for the children of the children of old medicine, with the help of normalization of the water-electrolyte, acid-puddle balance of the body in the organism.

Know the rules tehnіki Venue of іnfuzіynoї terapії in vіddіlennі anestezіologії that reanіmatsії potrіbno cutaneous lіkaryu anestezіologu-reanіmatolog so yak principle of holding іnfuzіynoї terapії reanіmatsіynim ailments not tіlki vіdrіznyayutsya od іnfuzії in іnshih vіddіlennyah and second roblyat її one of the main metodіv lіkuvannya at vazhkih mills.

SHO TAKE INFUSION THERAPY

Understanding about infusion therapy in reanimation includes not just parenteral administration for the treatment of singing pathology, but also a system of postal infusion on organism.

Infusion therapy is an intravenous parenteral administration of drugs and drugs. Obscene infusions of reanimated ailments can reach the end of the decilkokh letters to get and lie down as a sign of recognition.

Creation of infusion therapy, as well as understanding of infusion-transfusion therapy, is a method of controlling the functions of the body by way of improving the volume of blood, small and small internal diseases.

Infusion is often carried out in a cylodobous manner, which requires continuous internal access. For many we are sick to prevent central venous catheterization or venesection. In addition, for reanimation ailments, the ability to develop faster, as they covet term reanimation calls, is necessary, long-term access is necessary.

Tsіli, zavdannya

Infusion therapy can be carried out with shots, gastric pancreatitis, opikas, alcoholic intoxication - cause problems. How would you like to carry out infusion therapy? The main goals of reanimation:

Є y іnshі zavdannya, like to put in front of you. Tse viznachaє, scho to enter into infusion therapy, as a result of vikoristoyutsya in the skin area.

Shown and counter-shown

Indications before infusion therapy include:

• all kinds of shock (allergic, infectious-toxic, hypovolemic);
• lose birth by organism (bleeding, sore throat, opіk);
• the loss of mineral elements and bіlkіv (non-bleeding, diarrhea);
• damage to the acid-puddle balance of blood (ailments nirok, pechinki);
• otruunnya (lykarsky drugs, alcohol, drugs and other words).

Prototype indication before infusion-transfusion therapy is not insane.

Prevention of accelerated infusion therapy includes:

yak to see

Algorithm for carrying out infusion therapy of offensive:

• inspecting and identifying the main life indicators of the sick, if necessary - the heart-legendary reanimation;
• catheterization of the central vein, dyeing the blast and catheterization of the cuticle, schob stitching for the birth of the organism, as well as putting a shlunkovy probe (the rule of three catheters);
• the designation of a collection and a warehouse and an ear of infusion;
• additional advances and analyzes, їх timid already on the basis of the conducted treatment; the result is infused into the її yakіsny і kіlkіsny warehouse.

Obsyag i preparations

For the introduction of vicious drugs and drugs for infusion therapy, classification of solutions for internal introduction, showing meta їх values:

• crystal salt solutions for infusion therapy; additionally help to memorize the deficiency of salts and water, before them physiological breakdown, Ringer-Locke breakdown, hypertonic breakdown of sodium chloride, breakdown of glucose and іnshі;
• coloïdnі razchini; tse high and low molecular weight speech. Їx introduction is indicated for decentralization of blood circulation (Polyglyukin, Reoglyuman), for damaged microcirculation of tissues (Reopolyglyukin), for dents (Gemodez, neocompensan);
• blood preparations (plasma, erythrocytic mass); indicated for blood loss, disseminated intravascular coagulation syndrome;
• solutions, how to regulate the acid-water balance of the body (solutions to sodium bicarbonate);
• osmotic diuretics (Mannitol); zastosovayutsya for prophylaxis of the brain in case of stroke, craniocerebral trauma. The introduction is carried out on the basis of a forced diuresis;
• products for parenteral feeding.

Infusion therapy in reanimatology is the main method for treating reanimatics of ailments, and is generally carried out. Allowing the sick to be brought from the important camp, so that someone can continue to go further and rehabilitate in their new appearances.

5.4.1. General principle intensive therapy:

Even if ailments are delivered to the stage of hemorrhagic shock, infusion and medication correcting blood therapy, it is necessary to fix it without a mediocre approach in the most effective treatment and prolonged therapy in the course of intensive care!

In some cases, it is necessary to carry out during the period of intensive therapy for short-hour treatment of the sick person in the immediate area (laboratory treatment, endoscopic treatment, etc.).

The factor of the hour during the carrying out of infusion and drug therapy is the extremely important role in the result of the treatment of the sick, some of the earliest ear of drug calls allowing for the development of non-vortex snakes. In a number of vypadkіv docіlnо vikoristovuvati internal strumminno introduced rіdin.

Pidtrimka of the life of the patient, for the loss of organ dysfunction and for the loss of organ dysfunction - the head meta intensive therapy (IT). Її main components є:

- hemodynamic pidtrimka,

- respirator pidtrimka,

Suffocation of shlunkovaya secretion (preventing the development of stresses and diagnostics of shlunkovo-intestinal bleeding),

- nutritional nutrition,

- correction of blood coagulation disorders and prevention of glib venous thrombosis,

- Immunosubstitution therapy.

Arterial hypertension - є clutter up the life by the camp and in the course of conducting non-ad hoc visits, directing to the renewal of adequate perfusion of organs and tissues of the body. To that, if the patient has an arterial hypothesis - АДсіс. less than 75 mm Hg, arterial pressure less than 60 mm Hg і to know the signs of a low heart wikidu (confusion of testimony, cold shkirnі pokrivi, oliguria), it is necessary to carry out an extreme treatment.

About the shortage of circulating blood, the first for everything, to reduce low CVP (less than 5 mm Hg).

Principles of arterial hypothesis treatment:

1) renewal of the optimal volume of circulating blood.

2) Determination of hypoxia and correction of biochemical indicators.

3) Carrying out inotropic (vasopressor) therapy.

4) Specific identification of the reason for the arterial hypertension.

5.4.2. In the case of intensive therapy for ailments from the OKPPK in Persha Cherga, it is necessary to have a viconati come in:

Catheterize the central vein;

Determine the value of the CVP, as a key to diagnostics and additional help in the appointment of an infusion therapy;

Pidklyuchi EKG monitor;

Catheterize the sečovy mihur; number of sevovidrennya is an indicator of nirk blood flow and heart wikidum (in the norm 40-60 ml / year or 1 ml / min.).

5.4.3.Standard for monitoring in advanced intensive therapy includes:

EKG with heart rate p_drakhunkom;

pulse oximeter;

Validation of AT by a non-invasive method in automatic mode with an interval of 3-5 hilines;

Viznachennya TsVT;

capnography;

Viznachennya frequency dikhannya;

thermometry;

Pogodinny direz.

5.4.4. Hemodynamic pidtrimka.

Indicated for hemodynamic training:

1. AT less than 70 mm Hg.

2. СІ less than 3.5 l / hv / m 2

3. OPSS less than 1100 dyn.sec.cm -5

4. CVP less than 5 cm of water column.

5. Heart rate more than 110 beats / min.

Therapeutic options for hemodynamic training (Fig. 3):

1.Infusion drugs.

2. Vasopressors.

3. ionotropic therapy.

Kintseva meta of hemodynamic pidtrimka - renewal of effective perfusion of tissue and normalization of cell metabolism.

Small. 3. Algorithm of intensive therapy of arterial hypotension

Main department of infusion therapy:

- renewal of central hemodynamics;

- renewal of microcirculation and normalization of rheological powers of blood;

- normalization of transcapillary exchange;

- normalization of sour blood and renewal of sisnevo-transport function.

The average volume of infusions should become approximately 30 - 40 ml / kg of the weight of the sick person, or even 50-60 ml / kg and more. It’s a good idea to lie in the amount of blood loss, triviality of bleeding and compensatory capacities to the body. When there is a total amount of intravenous administration of the drug, the drug is guilty of overhanging the blood loss by 60-80%.

Criteria for the effectiveness of infusion therapy є:

CVP - 5-12 cm of water column;

Systolic arterial vise - ponad 100 mm Hg. Art.;

MAP - more than 70 mm Hg;

Dyuresis - 0.5 ml / kg / year;

Hematocrit - more than 30%;

Arterial blood / hemoglobin concentration is not lower than 92 mm Hg. Art.;

Saturation of blood in the upper empty vein is not less than 70%.

- tse vnutr_shnyovenne dribble or strumming the infusion of medical razchin_v for the singing scheme. Likarsk_ drugs, which come directly into the bloodstream, may reduce the availability. It is important to produce up to heat and exchange damage, as well as in the process of infusion therapy.

To carry out infusion therapy for the correction of pathological changes in the body:

• memorizing the deficiency of birth and electrolytes in the body, as well as wine through bluing and carrying;
• renewal of acid-puddles;
• vivedennya toxins;
• normalization of the robotic heart and of the vertebral tone;
• polishing of microcirculation and tissue dichotomy;
• prevention of thickening of blood, approval of blood clots.

showing

Infusion therapy should be carried out in an infectious hospital, or in case of emergency reanimation. Yaksho vi remembered one of them anxiety symptoms, Wiklikayte shvidku help:

How is infusion therapy carried out?

Medicinal solutions should be administered at the vena of the lyktyvka zgin or in the brush. For a wide variety of disposable sterile systems for speckle infusion. For convenience, place a peripheral catheter. In important cases, the preparations should be injected by means of a jet behind the aid of a syringe.

I have no access to the veins on my hands, and the camp will block my life, to put a catheter into the pidclavicular vein. The price of serious manipulation is to be carried out only by an anesthesiologist-resuscitator. Nadal medical sister a system for dribbbles is connected to the central catheter.

Infusion therapy includes two stages:

1. Basic - zapovnennya consumer in standard and electrolytes. Introduce physiological breakdown and 5% glucose.
2. Coriguyuchiy - revealing the deficiency of singing elements for additional analysis and correction. Vikoristovuyt a lot of components.

Vibir to the drug and the scheme of the introduction to lay down due to the nature of the communication problems. The main purpose of the infusion is to lay down from the mass and stage of the infusion.

• I (light) -130-170 ml / kg
• II ( average gravity) - 170-200 ml / kg
• III (important) - up to 220 ml /

During the first hour of infusion therapy, control of additional urine output, normal incidence of blood, instead of electrolytes in the blood, level of hematocrit. Based on the results of the analyzes, corrections are made to add the leads.

Group drugs

crystal

Kristaloidi - tse water solutions low molecular weight salts, form the basis of infusion therapy intestinal infections.

coloids

There is a group of solutions for rechovins, with a high molecular weight. In patients with crystalloids, coloids are more likely to vivod in the body, to circulate more in the blood. Їх stagnation with a turn of intoxication and low arterial vise... In case of intestinal infections, it is recognized:

Roschini for parenteral feeding

When the intestines are damaged, it is possible to lose the moisture of the living words, to produce a deficiency in the body. The approval of energy, the synthesis of bilkivs will collapse.

• Infezol - the range of amino acids and electrolytes.
• SMOFlipid - fatty emulsion, revenge sove and olive oil, triglyceride complex, rib fat.

Prototype

Internal infusion is recognized in case of an important interruption of intestinal infections, so all contraindications are evident. As soon as homeostasis is damaged, the patient's life is cluttered, infusion therapy should be carried out all the same.

• Fogging access to the peripheral veins. Place the central catheter only behind the living room.
• Pustules on the nape of the hands.
• Gostre psychotic disorder, behavior is inadequate. For carrying out the infusion of the patient, the patient must be fitted to the lid.
• Vidmova from the procedure.
• Allergic reaction to the drug.

accelerating

Internal infusion can lead to negative inheritance. The cleaning effect is due to the fault of the young people.