Postoperative complications. Prevention and treatment of postoperative complications

Content

After intervention in the body of a sick patient, a postoperative period is required, which is aimed at eliminating complications and providing competent care. This process is carried out in clinics and hospitals, it includes several stages of recovery. At each of the periods, attentiveness and care for the patient by a nurse, doctor's supervision is required to exclude complications.

What is the postoperative period

In medical terminology, the postoperative period is the time from the end of the operation to the complete recovery of the patient. It is divided into three stages:

early period - before discharge from the hospital;
late - after two months after the operation;
the remote period is the final outcome of the disease.

How long does it take

The end of the postoperative period depends on the severity of the disease and individual features body of the patient, aimed at the process of recovery. Recovery time is divided into four phases:

catabolic - an increase in the excretion of nitrogenous wastes in the urine, dysproteinemia, hyperglycemia, leukocytosis, weight loss;
period of reverse development - the influence of hypersecretion of anabolic hormones (insulin, growth hormone);
anabolic - restoration of electrolyte, protein, carbohydrate, fat metabolism;
a period of healthy weight gain.

Targets and goals

Follow-up after surgery is aimed at restoring normal activities of the patient. The objectives of the period are:

prevention of complications;
recognition of pathologies;
patient care - the introduction of analgesics, blockades, ensuring vital functions, dressings;
preventive actions to fight intoxication, infection.

Early postoperative period

From the second to the seventh day after the operation, the early postoperative period lasts. During these days, doctors eliminate complications (pneumonia, respiratory and renal failure, jaundice, fever, thromboembolic disorders). This period affects the outcome of the operation, which depends on the state of kidney function. Early postoperative complications are almost always characterized by impaired renal function due to the redistribution of fluid in the sectors of the body.

Renal blood flow decreases, which ends on 2-3 days, but sometimes the pathologies are too serious - loss of fluid, vomiting, diarrhea, impaired homeostasis, acute renal failure. Protective therapy, replenishment of blood loss, electrolytes, stimulation of diuresis help to avoid complications. Common causes of the development of pathologies in early period after surgery, shock, collapse, hemolysis, muscle damage, burns are considered.

Complications

Complications of the early postoperative period in patients are characterized by the following possible manifestations:

dangerous bleeding - after operations on large vessels;
abdominal bleeding - with intervention in the abdominal or chest cavity;
pallor, shortness of breath, thirst, frequent weak pulse;
divergence of wounds, defeat internal organs;
dynamic paralytic obstruction of the intestines;
persistent vomiting;
the possibility of peritonitis;
purulent-septic processes, the formation of fistulas;
pneumonia, heart failure;
thromboembolism, thrombophlebitis.

Late postoperative period

After 10 days from the moment of operation, the late postoperative period begins. It is divided into hospital and home. The first period is characterized by an improvement in the patient's condition, the beginning of movement around the ward. It lasts 10-14 days, after which the patient is discharged from the hospital and sent for home postoperative recovery, a diet, vitamins and activity restrictions are prescribed.

Complications

There are the following late complications after surgery that occur while the patient is at home or in the hospital:

postoperative hernia;
adhesive intestinal obstruction;
fistulas;
bronchitis, intestinal paresis;
repeated need for surgery.

The causes of complications in the later stages after surgery, doctors call the following factors:

a long period of being in bed;
underlying risk factors – age, disease;
impaired respiratory function due to prolonged anesthesia;
violation of asepsis rules for the operated patient.

Nursing care in the postoperative period

Plays an important role in patient care after surgery nursing care, which continues until the patient is discharged from the department. If it is not enough or it is performed poorly, this leads to poor outcomes and lengthening recovery period. The nurse must prevent any complications, and if they occur, make efforts to eliminate them.

The tasks of the nurse for postoperative care of patients include the following responsibilities:

timely administration of drugs;
patient care;
participation in feeding;
skin hygiene and oral cavity;
monitoring the deterioration of the condition and providing first aid.

From the moment the patient enters the ward intensive care the nurse begins her duties:

ventilate the room;
eliminate bright light;
arrange the bed for a comfortable approach to the patient;
monitor the patient's bed rest;
prevent coughing and vomiting;
monitor the position of the patient's head;
feed.

How is the postoperative period

Depending on the condition after the operation of the patient, the stages of postoperative processes are distinguished:

strict bed resting period - it is forbidden to get up and even turn in bed, it is forbidden to carry out any manipulations;
bed rest - under the supervision of a nurse or an exercise therapy specialist, it is allowed to turn in bed, sit down, lower your legs;
ward period - it is allowed to sit on a chair, walk for a short time, but examination, feeding and urination are still carried out in the ward;
general mode - self-service by the patient himself, walking along the corridor, offices, walks in the hospital area is allowed.

Bed rest

After the risk of complications has passed, the patient is transferred from the intensive care unit to the ward, where he should be in bed. The goals of bed rest are:

limitation of physical activation, mobility;
adaptation of the organism to the syndrome of hypoxia;
pain reduction;
restoration of strength.

Bed rest is characterized by the use of functional beds, which can automatically support the patient's position - on the back, stomach, side, reclining, half-sitting. Nurse takes care of the patient during this period - changes linen, helps to cope with physiological needs (urination, defecation) with their complexity, feeds and spends hygiene procedures.

Following a special diet

Postoperative period characterized by adherence to a special diet, which depends on the volume and nature of surgical intervention:

After operations on the gastrointestinal tract, enteral nutrition is carried out for the first days (through a probe), then broth, jelly, crackers are given.
When operating on the esophagus and stomach, the first food should not be taken for two days through the mouth. Produce parenteral nutrition- subcutaneous and intravenous intake of glucose, blood substitutes through a catheter, nutritional enemas are made. From the second day, broths and jelly can be given, on the 4th add croutons, on the 6th mushy food, from the 10th common table.
In the absence of violations of the integrity of the digestive organs, broths, pureed soups, jelly, baked apples are prescribed.
After operations on the colon, conditions are created so that the patient does not have a stool for 4-5 days. Food low in fiber.
When operating on the oral cavity, a probe is inserted through the nose to ensure the intake of liquid food.

You can start feeding patients 6-8 hours after the operation. Recommendations: observe water-salt and protein metabolism provide enough vitamins. A balanced postoperative diet for patients consists of 80-100 g of protein, 80-100 g of fat and 400-500 g of carbohydrates daily. For feeding, enteral mixtures, dietary canned meat and vegetables are used.

Intensive observation and treatment

After the patient is transferred to the recovery room, intensive monitoring begins and, if necessary, treatment of complications is carried out. The latter are eliminated with antibiotics, special medicines to maintain the operated organ. The tasks of this stage include:

assessment of physiological parameters;
eating according to the doctor's prescription;
compliance with the motor regime;
drug administration, infusion therapy;
prevention of pulmonary complications;
wound care, collection of drainage;
laboratory research and blood tests.

Features of the postoperative period

Depending on which organs have undergone surgical intervention, the features of patient care in the postoperative process depend:

Organs abdominal cavity- monitoring the development of bronchopulmonary complications, parenteral nutrition, prevention of paresis of the gastrointestinal tract.
Stomach, duodenum, small intestine - parenteral nutrition for the first two days, inclusion of 0.5 liters of liquid on the third day. Aspiration of gastric contents for the first 2 days, probing according to indications, removal of sutures on days 7-8, discharge on days 8-15.
Gallbladder - a special diet, removal of drainage, it is allowed to sit for 15-20 days.
Colon- the most sparing diet from the second day after the operation, there are no restrictions on fluid intake, the appointment of vaseline oil inside. Extract - for 12-20 days.
Pancreas - preventing the development of acute pancreatitis, monitoring the level of amylase in the blood and urine.
The organs of the chest cavity are the most severe traumatic operations, threatening blood flow disturbance, hypoxia, and massive transfusions. Postoperative recovery requires the use of blood products, active aspiration, and chest massage.
Heart - hourly diuresis, anticoagulant therapy, drainage of cavities.
Lungs, bronchi, trachea - postoperative fistula prevention, antibiotic therapy, local drainage.
Genitourinary system - postoperative drainage of urinary organs and tissues, correction of blood volume, acid-base balance sparing high-calorie food.
Neurosurgical operations - restoration of brain functions, respiratory capacity.
Orthopedic-traumatological interventions - compensation for blood loss, immobilization of the damaged part of the body, is given physiotherapy.
Vision - 10-12 hours bed period, walks from the next day, regular antibiotics after corneal transplantation.
In children - postoperative pain relief, elimination of blood loss, support for thermoregulation.

Postoperative period begins from the moment of completion of the surgical intervention and continues until the time when the patient's ability to work is fully restored. Depending on the complexity of the operation, this period can last from several weeks to several months. Conventionally, it is divided into three parts: the early postoperative period, lasting up to five days, the late one - from the sixth day until the patient is discharged, and the remote one. The last of them takes place outside the hospital, but it is no less important.

After the operation, the patient is transported on a gurney to the ward and laid on the bed (most often on the back). The patient, brought from the operating room, must be observed until he regains consciousness after vomiting or arousal, manifested in sudden movements, is possible when leaving it. The main tasks that are solved in the early postoperative period are prevention possible complications after surgery and their timely elimination, correction of metabolic disorders, ensuring the activity of the respiratory and cardiovascular systems. The patient's condition is facilitated by using analgesics, including narcotic ones. Of great importance is the adequate selection of which, at the same time, should not inhibit the vital functions of the body, including consciousness. After a relatively complex operations(eg, appendectomy) pain relief is usually required only on the first day.

The early postoperative period in most patients is usually accompanied by an increase in temperature to subfebrile values. Normally, it falls by the fifth or sixth day. May remain normal in older people. If it rises to high numbers, or only from 5-6 days, this is a sign of an unfavorable completion of the operation - as well as severe pain at the site of its implementation, which after three days only intensify, not weaken.

The postoperative period is also fraught with complications from the cardiovascular system - especially in individuals and if the blood loss during the operation was significant. Sometimes there is shortness of breath: in elderly patients, it can be moderately pronounced after surgery. If it manifests itself only for 3-6 days, this indicates the development of dangerous postoperative complications: pneumonia, pulmonary edema, peritonitis, etc., especially in combination with pallor and severe cyanosis. Among the most dangerous complications are postoperative bleeding - from a wound or internal, manifested by a sharp pallor, increased heart rate, thirst. If these symptoms appear, you should immediately call a doctor.

In some cases, after surgery, suppuration of the wound may develop. Sometimes it manifests itself already on the second or third day, however, most often it makes itself felt on the fifth or eighth day, and often after the patient is discharged. In this case, redness and swelling of the sutures are noted, as well as sharp pain during their palpation. At the same time, with deep suppuration, especially in elderly patients, its external signs, except for pain, may be absent, although the purulent process itself can be quite extensive. To prevent complications after surgery, adequate patient care and strict adherence to all medical prescriptions are necessary. In general, how the postoperative period will proceed and what its duration will be depends on the age of the patient and his state of health and, of course, on the nature of the intervention.

It usually takes several months for the patient to fully recover after surgery. This applies to all types of surgical operations - including, and plastic surgery. For example, after such a seemingly relatively simple operation as rhinoplasty, the postoperative period lasts up to 8 months. Only after this period has passed, it is possible to assess how successfully the nose correction surgery went and how it will look.

Complications in the postoperative period can be early and late.

Complications during resuscitation and early postoperative period

Cardiac arrest, ventricular fibrillation
Acute respiratory failure(asphyxia, atelectasis, pneumothorax)
Bleeding (from a wound, into a cavity, into the lumen of an organ)

Late complications:

Suppuration of the wound, sepsis of the function
Violation of the anastomoses
Adhesive obstruction
Chronic renal and hepatic insufficiency
Chronic heart failure
lung abscess, pleural effusion
Fistulas of hollow organs
Thrombosis and vascular embolism
Pneumonia
Intestinal paresis
Heart failure, arrhythmias
Insufficiency of sutures, suppuration of the wound, eventeration
Acute renal failure

Hemodynamic disorders

After severe traumatic operations, acute cardiovascular insufficiency may occur, hypertensive crisis. The state of the cardiovascular system can be judged by the pulse rate, the level of blood pressure.

Acute cardiovascular failure

Acute cardiovascular insufficiency develops after severe long-term interventions, when by the end of the operation the blood loss has not been replenished or hypoxia has not been eliminated. Such patients have tachycardia, low arterial and venous pressure, pale and cold skin, slow awakening from anesthesia, lethargy or agitation. In case of hypovolemia, blood loss is compensated - drugs of hemodynamic action, blood are transfused, prednisolone, strophanthin are administered.

Pulmonary edema

Acute heart failure is manifested by anxiety, shortness of breath. Cyanosis of the mucous membranes and extremities is rapidly growing. In the lungs, moist rales are heard, tachycardia is noted, arterial pressure may remain normal. Sometimes pulmonary edema with right ventricular failure proceeds at lightning speed. Most often, pulmonary edema develops gradually.

Treatment. Apply tourniquets to the upper and lower limbs to reduce blood flow to the heart. Produce inhalation with alcohol mixed with oxygen. To do this, alcohol is poured into the evaporator and oxygen is passed through it, which the patient breathes through the mask. Strofantin, furosemide are administered intravenously. Pressure in pulmonary artery reduce with arfonad or pentamin - from 0.4 to 2 ml of a 5% solution is administered carefully under the control of blood pressure. In severe cases, tracheostomy, sputum suction and mechanical ventilation are necessary.

Hypertensive crisis, myocardial infarction

In persons with hypertension in the postoperative period, a crisis may develop with a sharp rise in blood pressure. In such cases, limit the amount of transfused fluid and saline solutions administered drugs that lower blood pressure.

Patients suffering from angina pectoris are prescribed nitroglycerin - 2-3 drops of a 1% solution under the tongue, Zelenin drops, mustard plasters on the heart area, nitrous oxide with oxygen (1: 1) and for non-relieving pain 1 ml of a 2% solution of promedol.

Myocardial infarction after major operations can proceed atypically, without a pain component, but with motor excitation, hallucinations, tachycardia. The diagnosis is specified according to the ECG data. Therapeutic measures for myocardial infarction include.

– shock, bleeding, pneumonia, asphyxia, hypoxia.

Shock

The risk of shock as a complication after surgery is never excluded. In connection with the cessation of anesthesia and the weakening of the action of local anesthesia, pain impulses from the wound begin to come in increments. If you do not pay attention to this, then a secondary shock may develop. It was noted that secondary shock develops more often in patients who experienced primary shock during surgery.

To prevent shock, it is necessary to carry out local anesthesia at the end of the operation, introduce morphine, systematically give oxygen and continue drip transfusion in the ward, despite the presence of normal blood pressure in the patient.

It is noted that secondary shock in most cases develops in the first two hours after surgery. Therefore, blood transfusion by drip, rare drops, must be continued for at least 2 hours. If all this time blood pressure keeps within the normal range, drip blood transfusion can be stopped.

With the development of secondary shock, it is necessary to apply all the measures that are used in primary shock: oxygen, cardiac, glucose, blood transfusion. At stage IV of shock, intra-arterial blood transfusion is indicated.

Bleeding

Bleeding as a complication of the operation can occur both as a result of slipping of the ligature from a large vessel, from damaged intercostal arteries, and in the form of parenchymal bleeding from separated adhesions. The last type of this complication after surgery can also be observed with an overdose of anticoagulants.

Recognition of secondary bleeding is not so easy due to the fact that after the operation the patient is often either under anesthesia or in a state of varying degrees of shock.

The presence may facilitate the recognition of this complication after surgery by a significant amount of blood flowing through the drainage. Where there is no drainage and the cavity is tightly closed, only the clinical manifestation of internal bleeding can help to make the correct diagnosis.

According to clinical manifestations and general condition of the patient, and if possible by fluoroscopy performed on the spot, it is necessary to find out the degree of bleeding and its nature. If a ligature slippage from a large vessel is suspected, an immediate re-thoracotomy is indicated with simultaneous transfusion of massive doses of blood. With parenchymal bleeding, plasma transfusion and drip blood transfusion are indicated until blood pressure equalizes.

Asphyxia

As a complication after surgery, asphyxia is most often of local origin - due to mucus accumulated in the bronchi. To prevent, treat this complication after surgery, it is recommended to perform bronchoscopy at the end of the surgical intervention, and then and after it, to suck out the mucus with an aspirator. Considering that bronchoscopy is far from being an indifferent event, it is more rational to recognize the suction of mucus with an aspirator at the end of the operation through the intratracheal tube, before removing it. In the future, if accumulation of mucus is noted, which is determined by bubbling breathing or by the presence of coarse wheezing, it is recommended to local anesthesia insert the catheter through the nose into the trachea and suction the mucus with an aspirator from the entire tracheobronchial tree.

hypoxia

In the postoperative period, hypoxemia is often observed as a result of a violation of the oxygen supply to the body caused by an operating injury. With atelectasis, pneumonia and other complications after surgery, the phenomena of oxygen deficiency increase. Therefore, after the patient recovers from the state of shock, it is necessary to organize a series of measures to prevent and combat possible atelectasis and pneumonia in the remaining lung. It is necessary to make the patient cough very early, breathe deeply and ensure an uninterrupted supply of sufficient oxygen. Breathing exercises should be carried out from the 2nd day after the operation.

Atelectasis and pneumonia

After chest surgery, frequent and dangerous complications are atelectasis and pneumonia, dramatically increasing mortality and prolonging the recovery process.

Bronchial secretion retention is a common cause of postoperative pulmonary complications. A secret retained in the bronchial tree can cause blockage of the bronchus of the remaining lobe and lead to its atelectasis. As a consequence of this, there is a significant shift of the mediastinum to the diseased side, and radiologically - uniform shading of this part of the chest. In such cases, the patient should be advised to cough more vigorously, do breathing exercises, or invite him to inflate a rubber balloon or balloon. Quite often under the influence of these measures the atelectasis disappears.

Postoperative pneumonia is most often observed on the 2nd day after surgery as a result of the flow of bronchial secretions into the deep sections of the lung. However, acutely developed atelectasis and pneumonia are observed, which end fatally within a few hours. Such acute atelectasis and pneumonia are most often the result of aspiration of the purulent contents of a diseased lung into a healthy one during surgery. This complication after surgery is observed when the patient lies on the healthy side or he is not given a Trendelenburg position, and during manipulation on the diseased lung, a large amount of purulent content is “squeezed out” from it.

To prevent such complications after surgery, it is recommended when in large numbers purulent contents in the preoperative period to achieve its reduction, and during the operation to put the patient in the Trendelenburg position, without sharply lifting the diseased side.

In the first days, due to a decrease in respiratory excursions of the chest, there is a delay in the secretion in the bronchi, which is common cause postoperative pneumonia. To prevent these pneumonias great importance has suction of bronchial secretion by an aspirator at the end of the operation, breathing exercises.

In view of the fact that seriously ill patients do not tolerate intrabronchial administration, it should be recommended to administer antibiotics in the form of an antibiotic aerosol for the prevention and treatment of pneumonia.

Prevention of pneumonia is also the complete emptying of the pleural cavity from the accumulating fluid, which, squeezing the lung, certainly contributes to the development of atelectasis and pneumonia.

For the prevention of pneumonia in the postoperative period, antibiotics (intramuscularly) and cardiac are also used. With developed pneumonia, its treatment is carried out according to the generally accepted method.

The article was prepared and edited by: surgeon

After major operations, a serious condition usually develops as a response to severe, prolonged trauma. This reaction is considered as natural and adequate. However, in the presence of excessive irritations and the addition of additional pathogenetic factors, unforeseen conditions that aggravate the postoperative period (for example, bleeding, infection, suture failure, vascular thrombosis, etc.) may occur. Prevention of complications in the postoperative period is associated with rational preoperative preparation of the patient (see Preoperative period), the right choice anesthesia and its full implementation, strict observance of the rules of asepsis and antisepsis, careful handling of tissues by the surgeon during the operation, selection of the desired method of operation, good technique for its implementation and timely medical measures to eliminate various deviations in the normal course of the postoperative period.

Some time after a major operation, under the influence of pain impulses emanating from an extensive surgical wound, shock and collapse may develop, which is facilitated by blood loss. After a period of anxiety comes blanching skin, cyanosis of the lips, blood pressure drops, the pulse becomes small and frequent (140-160 beats in 1 min.). In the prevention of postoperative shock importance has pain relief. After extensive traumatic interventions, which inevitably cause prolonged and intense pain, they resort to the systematic administration of drugs not only at night, but several (2-3, even 5) times a day during the first two, and sometimes three days. In the future, the pain decreases, which allows you to limit the use of drugs (only at night, 1-2 days). If repeated use is necessary, it is better to use promedol rather than morphine. Some authors recommend to use superficial anesthesia with nitrous oxide to relieve pain in the postoperative period. At the same time, measures are needed to replenish blood loss and the appointment antihistamines(Dimedrol).

With the development of postoperative shock, the patient is warmed in bed, the foot end of the bed is raised and complex anti-shock therapy is carried out (see Shock). Upon withdrawal shock phenomena further actions are carried out according to individual indications.

Bleeding in the postoperative period may occur due to slipping of ligatures from gastric arteries, the stump of the auricle of the heart, the stump of the vessels of the root of the lung, the arteries of the stump of the limb, from the intercostal, internal thoracic, lower epigastric and other arteries. Bleeding can also start from small vessels that did not bleed during the operation due to a drop in blood pressure and therefore remained untied. In more late dates massive bleeding can occur on the basis of arrosion of the vessel during the development purulent process(so-called late secondary bleeding). Characteristic features acute bleeding are: severe pallor, frequent small pulse, low blood pressure, patient anxiety, weakness, profuse sweat, bloody vomiting, wetting of the bandage with blood; with intra-abdominal bleeding percussion in sloping areas of the abdomen with percussion, dullness is determined.

Treatment is aimed at stopping bleeding with simultaneous intravenous or intra-arterial blood transfusion. The source of bleeding is determined after opening the wound. Bleeding vessels are ligated during relaparotomy, rethoracotomy, etc. In hematemesis after gastric resection, conservative measures are initially carried out: careful gastric lavage, local cold, gastric hypothermia. If they are unsuccessful, a second operation with revision and elimination of the source of bleeding is indicated.

Postoperative pneumonia occur more often after operations on the organs of the abdominal and thoracic cavity. This is due to the common innervation of these organs (vagus nerve) and the limitation of respiratory excursions that occurs after such operations, difficulty in coughing up sputum and poor ventilation of the lungs. Stagnation in the pulmonary circulation, due to the lack of respiratory excursions and, in addition, the weakening of cardiac activity and the immobile position of the patient on his back, are also important.

Respiratory disorders with the subsequent development of pneumonia can also occur after a major operation in the cranial cavity. The source of pneumonia may be a postoperative pulmonary infarction. These pneumonias usually develop at the end of the first or beginning of the second week after surgery, characterized by severe pain chest and hemoptysis.

In the prevention of postoperative pneumonia, an important place is occupied by the introduction of painkillers; pain relief promotes deeper and more rhythmic breathing, facilitates coughing. However, morphine and other opiates should not be prescribed in large doses (especially with pneumonia that has already begun), so as not to cause oppression of the respiratory center. Heart remedies are very important - injections of camphor, cordiamine, etc., as well as proper preparation respiratory tract and lungs of the patient in the preoperative period. After the operation, the upper half of the body is raised in bed, the patient is turned more often, they are allowed to sit down, get up earlier, and therapeutic exercises are prescribed. Bandages applied to chest and stomach, should not restrict breathing. As therapeutic measures for pneumonia, oxygen therapy, banks, heart, expectorants, sulfanilamide and penicillin therapy are used.

At pulmonary edema there is a sharp shortness of breath with bubbling breathing, sometimes with hemoptysis. The patient is cyanotic, in the lungs there are many different moist rales. Treatment depends on the cause of the swelling. Apply cardiac, painkillers, bloodletting, oxygen therapy; fluid is aspirated from the tracheobronchial tree by intubation. If necessary, systematic, repeated aspiration, a tracheotomy is performed and the contents of the respiratory tract are periodically aspirated through a catheter inserted into the tracheotomy opening. The tracheotomy tube must always be passable; if necessary, it is changed or well cleaned. Liquefaction of the secretion of the respiratory tract is carried out using aerosols or washing. At the same time, oxygen therapy and other therapeutic measures are carried out. Patients are placed in separate rooms served by specially trained personnel. With a sharp violation of breathing, they resort to controlled artificial respiration with the help of a breathing apparatus.

Complications from the cardiovascular system. In the postoperative period, some patients develop relative heart failure, blood pressure drops to 100/60 mm Hg. Art., shortness of breath, cyanosis appear. ECG - increased heart rate, an increase in systolic index. The decline of cardiac activity with previously altered cardiovascular system associated with the load, which is caused by surgical trauma, anoxia, narcotic substances, neuroreflex impulses from the area of intervention. Therapy consists in the use of cardiac drugs (camphor, caffeine, cordiamine), painkillers (omnopon, promedol), intravenous administration of 20-40 ml of a 40% glucose solution with 1 ml of ephedrine or corglicon.

In the first three days after the operation, especially after severe traumatic operations on the organs of the chest and abdominal cavity, acute cardiovascular failure may occur. An effective measure in the fight against it is intra-arterial blood transfusion in fractional portions of 50-70-100 ml with norepinephrine (1 ml per 250 ml of blood). Favorable results are also given by the introduction into the vein of a 5% solution of glucose with norepinephrine. Along with this, cardiac agents are administered, the patient is warmed, and oxygen therapy is used.

Terrible complication of the postoperative period are thrombosis and embolism of the pulmonary artery (see Pulmonary trunk). The occurrence of thrombosis is associated with disorders of the blood coagulation system, and primary thrombi usually form in the deep veins of the leg. Prolonged stasis, weakening of cardiac activity, predispose to the formation of blood clots, age-related changes, as well as inflammatory processes. Prevention of thromboembolic complications consists in allowing the patient to move early after surgery and monitoring the state of the blood coagulation system, especially in elderly patients. With increased blood clotting (according to coagulogram data), anticoagulants are prescribed under the control of a systematic determination of the prothrombin index.

After abdominal surgery, it may occur dehiscence of the abdominal wound, accompanied by eventration (falling out) of the viscera. This complication is observed between the 6th and 12th day after the operation, mainly in malnourished patients with flatulence or severe cough that developed in the postoperative period. With eventration, an immediate operation is necessary - the reduction of the prolapsed organs and the suturing of the wound with thick silk. Interrupted sutures pass through all layers abdominal wall(except for the peritoneum) at a distance of at least 1.5-2 cm from the edges of the wound.

Complications from the gastrointestinal tract. With hiccups, the stomach is emptied with a thin tube, a 0.25% solution of novocaine is given to drink, and atropine is injected under the skin. Persistent, excruciating hiccups may necessitate the use of a bilateral novocaine phrenic nerve block in the neck, which usually results in good effect. However, persistent hiccups may be the only sign of localized peritonitis with subdiaphragmatic effusion. With regurgitation and vomiting, the cause that causes these phenomena is first identified. In the presence of peritonitis, it is necessary first of all to take measures to combat its source. Vomiting can be supported by stagnation of the contents in the stomach and the presence of flatulence in the patient due to dynamic obstruction (postoperative paresis) of the intestine. Flatulence usually occurs by the end of the second day after surgery on the abdominal organs: patients complain of abdominal pain, a feeling of fullness, difficulty in deep breathing. During the study, abdominal distention, high standing of the diaphragm are noted. To remove gases from the intestines, suppositories with belladonna are prescribed, a gas outlet tube is inserted into the rectum for a while to a depth of 15-20 cm, in the absence of effect, a hypertonic or siphon enema. Most effective tool combating postoperative dynamic obstruction of the gastrointestinal tract is a long-term suction of the contents of the stomach (see long-term suction).

A rare but severe complication in the postoperative period is an acute expansion of the stomach, which also requires constant drainage with a thin probe and at the same time general strengthening measures (see Stomach). Other serious illness, sometimes occurring in the postoperative period and proceeding with clinical picture paralytic ileus, is acute staphylococcal enteritis. Weakened, dehydrated patients in the coming days after surgery may develop parotitis (see). If parotitis becomes purulent, an incision is made in the gland, taking into account the location of the branches of the facial nerve.

In patients with pathological changes liver in the postoperative period, liver failure may develop, which is expressed in a decrease in the antitoxic function of the liver and the accumulation of nitrogenous slags in the blood. One of the initial signs of latent liver failure is an increase in the level of bilirubin in the blood. With obvious insufficiency, icterus of the sclera, adynamia, and enlargement of the liver occur. A relative violation of the antitoxic function of the liver is observed in the coming days in most patients who have undergone major interventions. With signs of liver failure, a carbohydrate diet is prescribed with the exclusion of fat, 20 ml of a 40% glucose solution is administered intravenously daily with simultaneous subcutaneous injections of 10-20 units of insulin. Inside appoint mineral water( , No. 17). They give atropine, calcium, bromine, cardiac drugs.

Violations are varied metabolic processes in the postoperative period. With persistent vomiting and diarrhea, intestinal fistulas, dehydration occurs due to the loss of large amounts of fluid, intestinal contents, bile, etc. Together with the liquid contents, electrolytes are also lost. Violation of the normal water-salt metabolism, especially after major operations, leads to heart and liver failure, a decrease in the filtration function of the renal glomeruli and a decrease in diuresis. In the event of an acute kidney failure decreases and stops the separation of urine, blood pressure drops to 40-50 mm Hg. Art.

In case of violations of water-salt metabolism, drip administration of liquids, electrolytes (Na and K), oxygen therapy is used; to improve kidney function, a pararenal blockade is performed. An indicator of improvement in kidney function is a daily urine output of up to 1500 ml with a specific gravity of about 1015.

With exhaustion, suppuration, intoxication after operations on the gastrointestinal tract, a violation of the protein balance may occur - hypoproteinemia. In combination with clinical data, the determination of proteins (total protein, albumins, globulins) is of great practical importance, being also one of the functional methods for assessing the state of the liver, where albumins and some globulins are synthesized. To normalize disturbed protein metabolism (to increase the amount of albumin by reducing globulins), parenteral administration of protein hydrolysates, serum, dry plasma is used, blood is transfused, and liver function is stimulated with medications.

Postoperative acidosis It is characterized mainly by a decrease in the alkaline reserve of the blood and, to a lesser extent, by an increase in ammonia in the urine, the accumulation of acetone bodies in the urine, and an increase in the concentration of hydrogen ions in the blood and urine. The severity of postoperative acidosis depends on the violation of carbohydrate metabolism after surgery - hyperglycemia. The complication often develops in women. The main cause of postoperative hyperglycemia is considered to be the weakening of the oxidative abilities of tissues, liver dysfunction plays a lesser role. Moderate postoperative acidosis does not give visible clinical manifestations. With severe acidosis, weakness, headache, loss of appetite, nausea, vomiting, and water-salt imbalance are noted. In the most severe cases, drowsiness, respiratory disorders ("big breath" Kussmaul), coma with a fatal outcome appear. Cases of this kind are very rare. With uncompensated postoperative moderate and severe acidosis, insulin therapy with glucose has been successfully used.

After extensive interventions, especially after complex operations on the organs of the chest and abdominal cavity, a condition often develops. hypoxia (oxygen starvation tissues). Clinically, hypoxia is characterized by cyanosis of the mucous membranes, fingertips, impaired cardiac activity, and deterioration in general well-being. To combat hypoxia, oxygen therapy is used in combination with glucose-insulin therapy.

A severe postoperative complication is hyperthermic syndrome, which develops in the next few hours after the operation as a result of disproportion in heat generation and heat transfer. Patients develop cyanosis, shortness of breath, convulsions, blood pressure drops, the temperature rises to 40 ° and even 41-42 °. The etiology of this condition is associated with the upcoming cerebral edema. Used as therapeutic measures intravenous administration significant amounts of hypertonic glucose solution, moderate hypothermia.