Preparation of patients for surgery and postoperative management

Preoperative preparation of patients depends on the violations. In case of impaired liver function assigned to large doses of vitamins, gipoproteinemii and gipoalbuminemii appointed transfusions of plasma albumin, sometimes, when hypersplenism, small doses of the blood. In violation vodno-elektrolitnogo exchange may require the correction, if ascites is the right selection of the most effective for each patient diuretics (aldactone), including osmodiuretics (sorbitol, mannitol). Hypokalemia is filled with oral or parenteral administration of drugs potassium. Taking into account the acid-base equilibrium is introduced sodium bicarbonate solution, and when azotemii (taking into account its degree) solution of glutamic acid (up to 30,0 net weight). Very effective application solutions of glucose with the appropriate insulin dose, cocarboxylase 50-100 mg cytochrome C.
The necessary care of the liver diet. If the patient before operation received corticosteroids, in any case, the dose they cannot reduce or even discontinue their purpose because of the danger of the emergence of "withdrawal syndrome".
In violation of blood coagulation (enhanced bleeding) are appointed hemostatic: fibrinogen, e-aminocaproic acid, thrombocyte suspension, thrombin, vitamin K and others Sometimes they have reasonable to combine and with heparin, if there is the threat of thrombosis (A. I. Lipsky, R. G. Sprintsson, 1968).
In the postoperative period desirable daily control of all biological disturbances and correction them depending on the extent of the changes. When applying for public Porto kafelnyh anastomoses during and after surgery used anticoagulant (heparin, leeches). The necessary oxygen: oxygen-protein foam inside, subcutaneous administration of oxygen. Often have to resort to parenteral nutrition of patients; paresis in the guts, it is advisable to install in the intestines ongoing probe Abbott-Miller. This is especially necessary if the bowel is shed abroad in his blood. To suppress the activities ottobrata microbes used antibiotics.
With an increase in hepatic and renal insufficiency patients first become drowsy, lethargic; later they hallucinations, delusions, agitation, increases rapidly jaundice, urine flow dramatically decreases the amount of residual nitrogen increases, the mouth appears a kind of "Apple", "liver" smell. In such cases, if not help of intensive therapy, shows the use of hemodialysis or temporary connection of heterophase. These activities should be undertaken, pending development of hepatic coma and has not appeared irreversible changes in the body.
The thoroughness of execution of complex of these measures allow us to bring the sick from prekomatosny and sometimes coma.
Ultimately, if the online manual about portal hypertension produced positions, time, and type of operation selected correctly, the remote results of persons, directly undergoing surgery (about 80% among the operated)look encouraging, with more than 80% of them we see 4 or 5 or even 10 years undoubtedly improved, and many of them were able to some extent to return to work.
Success depends not only on the successful definition of the indications for surgery and select it, but from careful described above, 2-4 months preparing patients for surgery, from the rational management of the postoperative period and further long-term management of these patients jointly by the surgeon and physician.