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Протокол анестезии при обширных резекциях печени: смена парадигмы под влиянием опыта трансплантации печени (обзор литературы)

Бельский В. А., Мольков А. М., Уткин И. А., Рабосина И. А., Загайнов В. Е.
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Бельский Владислав Александрович - главный специалист по анестезиологии-реаниматологии ФБУЗ ПОМЦ ФМБА России, ФБУЗ “Приволжский окружной медицинский центр” ФМБА России, 603109, г. Нижний Новгород, ул. Ильинская, д. 14, Российская Федерация
Мольков Александр Михайлович - врач анестезиолог-реаниматолог отделения анестезиологии - реанимации ФБУЗ ПОМЦ ФМБА России, ФБУЗ “Приволжский окружной медицинский центр” ФМБА России, 603109, г. Нижний Новгород, ул. Ильинская, д. 14, Российская Федерация
Уткин Иван Александрович - врач анестезиолог-реаниматолог отделения анестезиологии - реанимации ФБУЗ ПОМЦ ФМБА России, ФБУЗ “Приволжский окружной медицинский центр” ФМБА России, 603109, г. Нижний Новгород, ул. Ильинская, д. 14, Российская Федерация
Рабосина Ирина Анатольевна - врач анестезиолог-реаниматолог отделения анестезиологии - реанимации ФБУЗ ПОМЦ ФМБА России, ФБУЗ “Приволжский окружной медицинский центр” ФМБА России, 603109, г. Нижний Новгород, ул. Ильинская, д. 14, Российская Федерация
Загайнов Владимир Евгеньевич - доктор мед. наук, главный специалист по хирургии ФБУЗ ПОМЦ ФМБА России, заведующий кафедрой хирургических болезней ГБОУ ВПО НижГМА Минздрава России, ФБУЗ “Приволжский окружной медицинский центр” ФМБА России; ГБОУ ВПО “Нижегородская государственная медицинская академия” Минздрава России, vlad.belsky@gmail.com, 603109, г. Нижний Новгород, ул. Ильинская, д. 14, Российская Федерация

Представлен обзор современной актуальной литературы, включающий доказательные исследования, методические рекомендации, стандарты, руководства, посвященные анестезиологическому обеспечению расширенных резекций печени. На основании собранного материала проведен анализ существующих алгоритмов анестезии. Отмечены существенные различия подходов к анестезиологическому обеспечению, которые преимущественно обусловлены проблемой массивной интраоперационной кровопотери. Расширяющаяся практика трансплантации печени вносит существенные коррективы в проведение анестезии при этих оперативных вмешательствах. С учетом накопленного опыта обширных резекций и трансплантации печени выбран оптимальный алгоритм анестезиологического обеспечения.

Ключевые слова:
анестезия, печень, обширная резекция, мониторинг, инфузионная терапия, трансплантация, anesthesia, liver, extended liver resection, monitoring, infusion therapy, transplantation

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Anaesthesia Protocol to Extended Liver Resections: a Paradigm Shift under the Influence of the Experience of Liver Transplantation (Literature Review)

Belskiy V. A., Molkov A. M., Utkin I. A., Rabosina I. A., Zagainov V. E.

It is presented a review of current and the most relevant materials including evidence-based researches, guidelines, devoted to anesthesia during extended liver resections. Present algorithms of anesthesia were analyzed based on these data. It was noted significant differences in anesthetic approaches which are mainly explained by the problem of massive intraoperative blood loss. Expanding practice of liver transplantation is making significant adjustments to the carrying out of anesthesia during surgical intervention. Optimal algorithm of anestesia is determined based on the experience of extended liver resections and transplantations.

Keywords:
анестезия, печень, обширная резекция, мониторинг, инфузионная терапия, трансплантация, anesthesia, liver, extended liver resection, monitoring, infusion therapy, transplantation

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