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It is important to study changes in metabolism in patients with acute calculus cholecystitis (ACC) during laparoscopic cholecystectomy and to find ways to correct them. The aim of the study. To study the perioperative metabolism in ACC patients and evaluate the possibilities of its correction. Materials and methods. The study was prospective, not randomized. 129 patients with ACC, aged 36-84 years (54 men, 75 women), who underwent laparoscopic cholecystectomy, were studied. Preoperative risk ASA II-IV. General anesthesia with the use of the inhaled anesthetic sevoflurane and the narcotic analgesic fentanyl in low-flow mechanical ventilation. Perioperative intensive care was conducted in accordance with the International Standards for the Safe Anesthesiology Practice WFSA (World Federation of Societies of Anesthesiologists, 2010). In group I (n = 61) a retrospective energy audit was performed according to the protocols of anesthesia of medical histories and calculations of indirect calorimetry with the determination of current the Metabolic Rate (MR) and Basal Metabolic Rate (BMR). In group II (n = 68), operational monitoring was supplemented by the use of indirect calorimetry to determine MR, BMR, Target Metabolic Rate (TMR) and the degree of Metabolic Disorders (MD) (MD = 100 × (TMR-MR)/TMR %), and intensive care is supplemented by additional infusion therapy and glucocorticoids, taking into account the dynamics of metabolic changes. Results. The initial parameters of metabolism, in both groups, were without disturbance, and MR significantly exceeded BMR (in group I - by 30,5%, in group II - by 28,8%) and had the following values: in group I - 749±12 cal×min-1×m-2, in group II - 756±13 cal×min-1×m-2. In both groups, at the stage of the reverse position of Trendelenburg, the imposition of pneumoperitoneum and the beginning of the operation, significant metabolic disorders were observed with MR reduction to the basal level. Slow recovery of MR was observed in patients of group I, the value of which at the time of awakening remained 7,6% below baseline (p |
