rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2020-6-105-128rmt-1989Research ArticleОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯREVIEWS & SHORT COMMUNICATIONSПрименение ацетат-содержащих сбалансированных кристаллоидных растворов при проведении оперативных вмешательств на органах брюшной полости (обзор)Use of Acetate-Buffered Crystalloid Solutions for Fluid Therapy in Abdominal Surgery (Review)КрысановИ. С.KrysanovI. S.

Иван Сергеевич Крысанов

125080, Москва, Волоколамское шоссе, д. 11; 141008, Московская обл., Мытищи, Новомытищинский пр-т, д. 21/6; 105064, Москва, ул. Воронцово поле, д. 12, стр. 1

Ivan S. Krysanov

11 Volokolamskoe highway, 125080 Moscow; 21/6 Novomytishchinsky prospect, 141008 Mytishchi, Moscow region; 12 Vorontsovo pole Str., building, 1105064 Moscow

krysanov-ivan@mail.ruКрысановаВ. С.KrysanovaV. S.

125080, Москва, Волоколамское шоссе, д. 11; 143403, Московская обл., Красногорск, ул. Карбышева, д. 4; 119991, Москва, ул. Трубецкая, д. 8

Vera S. Krysanova

11 Volokolamskoe highway, 125080 Moscow; 4 Karbysheva Str,143403 Krasnogorsk, Moscow region; 8 Trubetskaya Str., Bldg. 2, 119991 Moscow

ЕрмаковаВ. Ю.ErmakovaV. Yu.

125080, Москва, Волоколамское шоссе, д. 11; 141008, Московская обл., Мытищи, Новомытищинский пр-т, д. 21/6; 119991, Москва, ул. Трубецкая, д. 8

Viktoriya Yu. Ermakova

11 Volokolamskoe highway, 125080 Moscow; 21/6 Novomytishchinsky prospect, 141008 Mytishchi, Moscow region; 8 Trubetskaya Str., Bldg. 2, 119991 Moscow

Медицинский институт непрерывного образования, Московский государственный университет пищевых производств; Институт клинико-экономической экспертизы и фармакоэкономики; Национальный научно-исследовательский институт общественного здоровья им. Н.А. СемашкоРоссияMedical Institute of Continuing Education, MSUFP, Moscow State Food Production University; Institute of Clinical and Economic Assessment and Pharmacoeconomics; N.A. Semashko National Research Institute of Public HealthRussian FederationМедицинский институт непрерывного образования, Московский государственный университет пищевых производств; Научно-практический центр клинико-экономического анализа Минздрава Московской области; Первый Московский государственный медицинский университет им. И. М. Сеченова Минздрава РоссииРоссияMedical Institute of Continuing Education, MSUFP, Moscow State Food Production University; Clinical and Economic Analysis Scientific-Practical Center, Ministry of Health of Moscow Region; I.M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaRussian FederationМедицинский институт непрерывного образования, Московский государственный университет пищевых производств; Институт клинико-экономической экспертизы и фармакоэкономики; Первый Московский государственный медицинский университет им. И. М. Сеченова Минздрава РоссииРоссияMedical Institute of Continuing Education, MSUFP, Moscow State Food Production University; Institute of Clinical and Economic Assessment and Pharmacoeconomics; I.M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaRussian Federation202030122020166105128Copyright © Крысанов И.С., Крысанова В.С., Ермакова В.Ю., 20202020Крысанов И.С., Крысанова В.С., Ермакова В.Ю.Krysanov I.S., Krysanova V.S., Ermakova V.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/1989

В ряде работ показана эффективность сбалансированных ацетат-содержащих кристаллоидных растворов. Однако, как в зарубежной, так и в отечественной литературе данный вопрос освещен недостаточно. Последние опубликованные данные выявили необходимость систематизации полученной информации.

Цель исследования

Цель исследования: оценить клиническую эффективность и безопасность различных вариантов инфузионной терапии с применением сбалансированных ацетат-содержащих кристаллоидных растворов при проведении оперативных вмешательств на органах брюшной полости.

Материалы и методы

Материалы и методы. Поиск информации провели в августе 2019 г — мае 2020 г. (дополнительный поиск в ноябре 2020 г.) по терминам, по ключевым словам, «acetate» AND «buffers» OR «buffered» AND «crystalloid solutions» OR «crystalloids» в базах данных Medline, Cochrane и eLIBRARY.ru. Критерии поиска определили в соответствии со схемой PICO(S). Глубина поиска — 10 лет. Отбор публикаций провели согласно руководству PRISMA. Определили уровни убедительности и доказательности отобранных исследований.

Результаты

Результаты. Из 62 найденных публикаций было 11 полнотекстовых публикаций, из которых 6 вошли в итоговый обзор. Сбалансированный режим инфузионной терапии не нарушает физиологический водно-электролитный баланс и кислотно-основное состояние (КОС), способствует сохранению гомеостаза, приводит к уменьшению объема интраоперационной кровопотери и выраженности почечной дисфункции. Использование ацетата в качестве буферного компонента оказывает поло жительное влияние на почечную и печеночную микроциркуляцию, не связано с развитием метаболического алкалоза, не приводит к значимым изменениям КОС и способствует сохранению концентрации калия в сыворотке крови. При этом применение различных ацетат-содержащих сбалансированных кристаллоидных растворов обладает сопоставимой клинической эффективностью.

Заключение

Заключение. Доказательства эффективности применения сбалансированных ацетат-содержащих кристаллоидных растворов в отношении КОС и гемодинамических показателей при проведении оперативных вмешательств на органах брюшной полости признаны убедительными с уровнем рекомендаций А.

Infusion therapy is one of the most frequently prescribed treatments in hospitalized patients. Fluid maintenance and resuscitation is an important strategy in major surgery. Acetate-buffered balanced crystalloid fluids may influence acid-base status, intracellular and extracellular water content, plasma electrolyte composition and have a favorable impact on renal, hepatic, and splanchnic microcirculation.

Aim was to evaluate current evidence of efficacy and safety of acetate-buffered crystalloid solutions for fluid therapy in abdominal surgery in adults.

Materials and methods

Materials and methods. Medline, the Cochrane Library, eLIBRARY.ru were searched up to 31 May 2020 (additional search in November 2020) using the key words «acetate» AND «buffers» OR «buffered» AND «crys-talloid solutions» OR «crystalloids». Studies published after 2009 in English and Russian were included. Systematic review was conducted in accordance with PRISMA guidelines using specified PICO(S) criteria.

Results

Results. The total of 62 studies were identified from all databases. Out of them 11 full-text publications were considered eligible, 6 of them were included into the final review. Acetate-buffered crystalloid solutions have a favorable impact on microcirculation. Metabolic alkalosis after the fluid infusion did not occur in all the studies; potassium levels remained stable, also.

Conclusion

Conclusion. Efficacy (based on acid-base status, hemodynamic parameters) of the acetate-buffered crystalloid solutions for fluid therapy during the abdominal surgery in adults patients was confirmed with the A level of evidence.

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