Objective. To determine the tactics of infusion therapy in patients with ischemic stroke (IS) depending on the severity of the violation of energy-structural status (ESST).
Materials and methods. A study of 32 patients with severe IS on the National Institutes of Health Stroke Scale (16,7±1,5), who were in the department of anesthesiology with intensive therapy units of the Municipal Non-Profit Enterprise «City Hospital № 9» Zaporizhzhia City Council. Of these, 11 were men (34,4 %; the average age – 68,2±2,5 years), 21 were women (65,6 %; average age – 72,1±1,6).
Results and discussion. In patients with IS, disorders ESST were defined as hyperergic damage at values of cardiac index (CI) of 4,45-5,09 L×min-1×m-2 and oxygen consumption index (IVO2) 186-210 ml×min-1×m-2, and at values of CI ≥5,10 L×min-1×m-2 and IVO2 ≥211 ml×min-1×m-2 – as hyperergic insufficiency. While hypoergic damage ESST occurred at values of CI 2,33-1,82 L×min-1×m-2 and IVO2 104-85 ml×min-1×m-2, and at CI ≤1,81 L×min-1×m-2 and IVO2 ≤84 ml×min-1×m-2 hypoergic insufficiency of ESST was observed. The daily fluid requirement of a patient with IS was calculated according to the formula 4+2+1: for the first 10 kg of weight – 4 ml×kg-1×h-1; from 11 to 20 kg – 2 ml×kg-1×h-1; from 21 kg – on 1 ml×kg-1×h-1 (Park G.R., Roe P.G., 2005; Netyazhenko V.Z., Halushko O.A., 2012).
Infusion therapy in patients with IS and hyperergic damage ESST was performed with 0,9 % sodium chloride solution according to the formula 4+2+1 on the background of the use of esmolol intravenously bolus 250 mg and subsequent administration of 50 mсg×kg-1×min-1, and in hyperergic insufficiency 500 mg of esmolol intravenously bolus and subsequent administration of 100 mсg×kg-1×min-1. While in hypoergic damage ESST on the background of infusion therapy used dopamine or dobutamine 1-5 mсg×kg-1×min-1, and in hypoergic insufficiency, the dose of dopamine or dobutamine was increased to achieve the desired effect.
Conclusions. The personification of infusion therapy depending on the severity of the violation of ESST can improve the results of treatment of patients with IS in the most acute period.
Optimization of the intensive therapy of multiorgan violations for critical patients with an ischemic stroke
