CHANGES OF AMPLITUDE-FREQUENCY SPECTRUM VIBRATIONS OF BLOOD FLOW DURING OPERATIONS IN PATIENTS WITH ADHESIVE INTESTINAL OBSTRUCTION

A key stage in the course of surgical diseases is the intraoperative period, which lays down the main pathogenic mechanisms for the further development of the disease and postoperative complications. One of the main factors in the development of complications in the postoperative period are microcirculatory disorders during surgery, which affect the main pathogenic mecha-nisms of the further course of the disease. Among many methods of studying the microcir-culation state, laser Doppler flowmetry, which makes it possible to monitor the perfusion of peripheral tissues throughout the surgical intervention, is quite convenient, informative and non-invasive. The Aim of the study is to investigate the changes of the amplitude-frequency spectrum of fluctuations of blood flow during the intraoperative period in patients with adhesive intestinal obstruction by conducting laser Doppler flowmetry. Materials and methods of research. We examined 57 patients with acute adhesive intestinal obstruction. Among them, 31 patients were operated open-ended and 26 patients, who had undergone less invasive intervention. For the analysis of the microcirculatory channel state and mechanisms for its regulation, laser Doppler flowmetry was performed. The examinations were carried out continuously during the entire surgical intervention. During the survey, we evaluated both the baseline microcirculation and the amplitude-frequency spectrum of blood flow fluctuations. The analysis of the amplitude-frequency spectrum of blood flow fluctuations was performed using wavelet-analysis. Research results. It was established that during the surgical intervention the microcirculatory channel state changes depending on the period of surgical intervention. Regardless of the type of surgical intervention in the first period of operation, growth of all amplitudes of fluctuations of blood flow is noted. This indicates an increase in blood supply to tissues, the activation of all active components of blood flow regulation (endothelial, neurogenic and myogenic) as a consequence of stress, activation of the sympatho-adrenal system and the reaction of the body to the administration of drugs for anesthesia and premedication. Subsequently, in laparotomic surgical interventions, changes were observed indicating a decrease in the blood supply of peripheral tissues, an increase in the resistance of arterioles, and a violation of the outflow of blood from the capillary bed. In laparoscopic surgical interventions in subsequent periods of the operation, significant changes in blood flow regulation, especially at the end of surgical interventions, were detected. In particular, a sharp decrease in the influence on the microcirculation of endothelial and neurogenic components with a sharp increase in the influence of myogenic, respiratory and cardiac factors was revealed. This indicates an increase in pressure in the capillaries, the occurrence of stagnation and overflow of the capillary bed, which can lead to severe hypoxia and thrombosis. Conclusions. The obtained results indicate significant changes in the level of the microcirculation system, such as stagnation in the venous system, overflow of the capillary bed, which can lead to hypoxia of organs and systems, development of dysfunction of parenchymal organs, increased risk of thromboembolic complications, etc. Thus, both open and laparoscopic surgical interventions have, in relation to the studied parameters, their advantages and disadvantages that need to be addressed during surgical treatment of adhesive intestinal obstruction.