SYNDROME OF INTESTINAL INSUFFICIENCY AS A FACTOR OF ANESTHETIC AND SURGICAL RISK IN TREATMENT OF PATIENTS WITH SPINAL TRAUMA

Abstract

Objective. To study a clinical symptom complex as a risk factor associated with injuries at T12-L5 levels due to the trauma or vertebral surgery and determined as a syndrome of intestinal insufficiency.

Material and Methods. The clinical study included 462 patients in whom reduction of the syndrome of intestinal insufficiency was performed in accordance with suggested protocol (study group) and 462 patients who received standard treatment (control group). Anesthetic management (n = 844) included standard multicomponent total intravenous anesthesia and artificial lung ventilation based on propofol or midozalam, fentanil and myoplegia with atracurium. Combined general anesthesia followed by continued epidural analgesia was used in 80 patients. Patients of both groups underwent phonoenterographic, chronographic, clinical biochemical, and bacteriological studies in the perioperative period.

Results. Syndrome of intestinal insufficiency is a natural manifestation and is registered in 88.4 % patients after trauma. Suggested protocol for its prevention permits to reduce preoperative bed-days by 5.0 ± 0.9 days and to decrease the frequency of grade III intestinal insufficiency syndrome by 2.6 % and of grade II – by 12.4 %.

Conclusion. The suggested treatment algorithm makes it possible to prevent and decrease the rate and length of intestinal insufficiency syndrome. Developed device (phonoenterograph) and a proposed criterion for quantitative and qualitative evaluation of the syndrome intensity allow to assess the efficacy of treatment and preventive program.