Ингаляционная анестезия у детей: современные возможности.

Аннотация

Parenteral feeding in children, who are in critic condition, is one of the more complicated problems in intensive therapy. There are no common opinions in the solution of this problems not only in practice, also and in the world literature. There are no criteria and recommendations for using parenteral feeding in children in the intensive therapy unite. The main indication for conducting of nutritious support in critic conditions is metabolic requirement, also loss of proteins and nutrients. Nutritious support is directed to prevent development of severe exhaustion (protein-energetic insufficiency) in the background of hyper catabolism and hypermetabolism, syndrome of enteral insufficiency at the developing multi-organ dysfunction or its high probability, Key words. Septic shock, phenomenon, nutritional support, sepsis in pediatrics. Introduction. Enteral insufficiency is one of the main causes of endogen intoxication, syndrome of systematic inflammation response, septic shock and multi-organ insufficiency. [1] Developing critic violation of water-electrolyte balance, circulator hypoxia of intestine’s wall, dysbacteriosis with proximal microbe colonization of intestine, considerable violation of antioxidant protection, local immunities and barer function of mucous membrane, phenomenon of progression “bacterial translocation” - just not many of these changes, which characterized this symptom complex.[2] There is well-known the fact, that the younger child, the more intensity of exchange processes in him and the more energy is needed for covering expenditure of energy, associated with intensive growth, development, substances’ exchange and supporting of main vital fiinctions[3] Therefore, the most important task for assigned nutritive support in intensive therapy is not only support of important proteins level and energy requirement, also prevent developing multi-organ insufficiency, creating condition for processes of restoration and up-growth of tissue [4]. All of the above-mentioned gives evidence about extreme importance adequate nutritious support in children, which are in critic condition [5]. The aim developing standard protocol of covering energetic demand in children, which are in critic condition, efficiency of which is already proved in randomized clinic studies in children with purulent-inflammatory processes, intestinal ileus, peritonitis, intestinal fistulas, necrotic colitis, severe sepsis with multi-organ dysfunction. Materials and methods. 47 patients with different somatic and surgery pathologies, who had been treated in the children intensive care unit at Republican research center of emergency medicine during 2019 - 2020 years, are exanimated and studied. The average age of children - 1.3 ±0.5 year. Due to the type of nutritious support, the patients were divided 2 groups: 1 group - nutritious support with full parenteral(Selemin5%,Sepid, glucose 15-20%) 2 group - nutritious support is conducted with artificial special mixtures (or decanted maternal milk for children till 1 year old) + partial parenteral feeding with using amino acids (Selemin 5%, Imin and 15% glucose). For valuation efficiency conducting therapy there is conducted measurement of following characteristics: A) anthropometric indexes - measurement of body mass ( 1 time in a day), measurement circumference of shoulder (1 time per 3-5 days) and thickness of cellulocutaneous cover ( 1 time per day). B) biochemical indexes - level of proteins, proportion of protein fractions, level of albumin, bilirubin, transaminase, triglycerides, acid-base balance and gases of blood (Astrup’s micromethod). For valuation of endogen intoxication dynamics, there are studied: lymphocytes, leukocytes, leukocytic index of intoxication, average molecules level. Also, there are evaluated patient stay duration in intensive care unite, lethality in groups. Results .During calculation of energy demand in children at the different critic conditions, there is established that, the last one is waved within the limits 30-50 kkal/kg/day (at intensive hypercatabolism). For effective synthesis of endogen proteins, there is important to keep correlation of not proteins calorie to general nitrogen in average 1-gram nitrogen to 120-150 kkal. Carbohydrates are entered in the doses 6 gr/kg/day, with subsequent increasing till 2 gr/kg/day. Concentration of glucose solution is selected based on the general volume of infusion therapy (generally 15-20% solutions). By fifth days doses of carbohydrates reached maximally 15-16 gr/kg/day. Control was conducted due to checking out of glucose level in the blood till 2 times per day. In the case of high glucose level, correction was conducted using insulin 0.5 unit/kg. The high limit of dedicated glucose - 16. Demand for protein substrates as general nitrogen load is - 0.20-0.35 gr/kg/day, that corresponds to requirement for proteins 1.25-2.5 gr/kg/day. The modem standard is using only- crystalloid amino acid solutions. We st