Вплив карбоксиперитонеуму на серцевий індекс у пацієнтів з морбідним ожирінням та супутньою серцево-судинною патологією під час лапароскопічних баріатричних втручань

Objective. To investigate the impact of carboxyperitoneum on indices of central hemodynamics in patients, suffering morbid obesity (МО) and concurrent cardio-vascular pathology (СVP) during laparoscopic bariatric interventions. Маterials and methods. In the investigation 45 patients, having МО and the body mass index 37 - 58 kg/м2, ageing from 18 tо 61 yrs old, were included, in whom laparoscopic bariatric interventions were performed. Concurrent СVP was revealed in 100% of the patients. In all the patients intraoperatively a combined inhalation  low-streaming anesthesia with sevofluran in combination with perioperative multimodal anesthesia was conducted. Indices of central hemodynamics were оbtained mathematically. Statistical elaboration of the investigation result was done with the help of the pool analysis of statistical data MedCalc v. 18.11 (MedCalc Software Inc, Broekstraat, Belgium). Results. Using correlation analysis there was established, that a change of absolute value of the cardiac index (СІ) correlates with intraabdominal pressure (IAP) in setting of carboxyperitoneum. Strong positive linear link was revealed (r=0.83; p < 0.001) between values Δ СІ and IAP. Critical value of IAP in environment of carboxyperitoneum constitutes 15 mm Hg: sensitivity – 93.1% (95% CI – ВІ 77.2% – 99.2%), specificity – 100% (95% ВІ 79.4% – 100%), prognostication of positive result - 100% (95% ВІ 93.2% – 100%), prognostication of negative result – 88.9% (95% ВІ 67.7% – 96.8%). Conclusion. Durable carboxyperitoneum in pressure 15 mm Hg do not lead to significant hemodynamical changes in patients with МО and coexistent СVP and is optimal for them.