Influence of blood loss on organism.

PROTECTIVE-COMPENSATE REACTIONS

Developing posthemorragic hypovolume leads to disorder the circulations of blood in an organism. The protective-compensate processes directed on renewal of the circulatory blood volume accordance and capacity of vascular river-bed are included as a result, the same an organism by the adaptive reactions provides maintenance of circulation of blood. The indicated reactions include 3 basic mechanisms:

1. Reduction of volume of vascular river-bed due to the rise of tone of veins (venospasm) and peripheral arteriol (arteriolospasm).

2. Compensation of the lost part circulatory blood volume due to autohemodilution because of moving of intercellular liquid in an of the circulatory system river-bed and output of blood from a depot.

3. Compensate reaction of organs of life-support (heart, lights, buds).

A similar compensate reaction can not proceed long time, the developing state of vascular resistance leads compensations to derangement.

Hypoxia of liver, buds, hypodermic cellulose causes serious metabolic violations.

Making of violations in an organism to progress is conditioned rouleau red corpuscles in capillaries because of their spasm and deceleration of bloodstream, and also increasing hypoxia of fabrics. In the exchange of matters anaerobic processes prevail over aerobic, acidosis grows to the tissue. Such violations of tissue metabolism and microcirculation are led to polyorganic insufficiency: in buds diminishes or is halted glomerular filtration and developed oliguria or anuria. In a liver there are necrotic processes, retractive power of heart because of defeat of myocardium goes down, the interstitial edema with violation of interchange of gases through a pulmonary-capillary membrane develops in lights («shock lung»).

Thus, even at the stopped bleeding the loss of blood causes serious changes of all systems of vital functions of organism, that necessitates the use of the most various facilities and methods of medical treatment, among which filling of blood loss is in basic, and than it is executed before, so much the better for a patient.

Stop of bleeding

Bleeding from shallow arteries and veins, and also from capillaries in most cases is halted spontaneously. Rarely comes independent stop of bleeding from large vessels.

One of the important protective systems of organism is the system of blood rolling up. Spontaneous hemostasis in a number of cases allows an organism to manage with bleeding independently.

Hemostasis – difficult biochemical and biophysical process which a blood vessel and surrounding him fabrics participate in, trombocyte and plasma factors of rolling up the anticoagulant systems of blood.

Abbreviation of smooth muscle cages of vessel results in vasoconstriction, in the area of damage of vessels broken endothelium creates a surface, place for formation of blood clot; change of hemodinamics, do deceleration of bloodstream possible process of trombogenesis, and tromboplastin of the damaged vessel and surrounding fabrics (tissue tromboplastin) takes part in the process of rolling up of blood. Change of electric potential of the damaged vessel, baring of kollagen, provide accumulation of active biochemical matters (glykoproteide, the Villebrand factor, ions of calcium, trombospandin and other) adhesion of trombocytes to bare kollagen of wall of vessel. Sticking trombocytes create terms for agregation of trombocytes – difficult biochemical process with participation of adrenalin, ADP, trombina with formation of arachidonic acid, prostaglandin, tromboxan and other matters. Aggregated trombocytes together with trombine and fibrin form a trombocyte clot – surface for subsequent trombogenesis with participation of the system of blood rolling up.

In a 1th phase, rolling up takes place with participation of plasma factors (The VIII, IX XI, XII factor of Hageman) and trombocytes of blood – bloody tromboplastin appears. The last together with tissue tromboplastin in presence the Ca ions translates protrombin in trombin (2th phase of fastening), and trombin in presence the XIII factor translates fibrinogen in fibrinpolimer (3th phase); the process of formation of clot is finished retraction last with forming of blood clot. The same hemostasis is provided, and bleeding from shallow vessels is reliably stopped. All process of trombogenesis takes place very quickly – during 3-5 mines, and such processes, how adhesion of trombocytes is, transition of protrombin in trombin, formation of fibrin, is occupied by a few seconds.

The proceeding bleeding, in case if an organism did not manage with him independently, serves by a testimony for the temporal stop of bleeding.

Methods of temporal stop of bleeding. Imposition of plait is the most reliable method, however he is used in area of extremities mainly.

The finger pinning of artery on the extent is produced in those areas, where arteries are disposed superficially and near a bone.

Bending of extremity in a joint effectively on condition of fixing of arcuated completely hand in an elbow joint at bleeding from the vessels of forearm or brush, and feet – in a knee-joint at bleeding from the vessels of shin or foot.

The tamponada wounds and imposition of pressing bandage with immobilization on condition of the elevated position of extremity are the good method of temporal stop of bleeding from veins and small arteries, from soft fabrics, covering bone skulls, elbow and knee joints.

Pinning of vessel in a wound by fingers carry out in urgent situations, sometimes during the operation.

The temporal shunting of vessel is the method of renewal of circulation of blood at the damage of large arterial vessels.

The methods of final stop of bleeding divide by 4 groups: 1) mechanical, 2) physical, 3) chemical and biological, 4) combined.

Mechanical methods. Bandaging of vessel in a wound is the most reliable method of stop of bleeding. For his realization the central and peripheral ends of bleeding vessel are selected, take them by styptic clamps and bandage.

Bandaging of vessel on the extent is used, if it is impossible to discover the ends of bleeding vessel in a wound (for example, at the wound of outward and internal carotids), and also at the second bleeding, when an arrosive vessel is found in the layer of inflammatory infiltrate. In such cases, oriented on topographic and anatomical data, find, bare and bandage a vessel out of wound. However this method does not guarantee stopping of bleeding from the peripheral end of the damaged artery and collaterals.

At impossibility of isolation of ends of vessel bandaging of vessel is produced together with surrounding soft fabrics. If a vessel is taken by a clamp, but bandaging him is not succeeded, it is had to abandon a clamp in a wound on long time — to 8-12 days, while will not happen reliable trombing vessel.

The damaged vessels of small caliber can be taken by a styptic clamp and rotatory motions to produce twirling of vessel.

Sometimes at presence of small wounds and damages of vessels of shallow caliber it is possible to produce tampon wounds. Tampons apply dry or moisten by physiological solution. Are the typical examples of stop of bleeding front and back tampon nose at the nose-bleed, tampon uteruses at the uterine bleeding.

At bleeding from vessels which it is difficult or it is impossible to bandage, use klipping – jamming of vessels by silver klips. After the final stop of the intracavitary bleeding parts of organ (for example, resection of stomach with a bleeding ulcer) or all organ are deleted (splenectomy at the break of spleen). The special stitches are sometimes laid on, for example on the edge of the damaged liver.

Presently for the stop of the pulmonary, gastrointestinal bleeding and bleeding from bronchial arteries, vessels of brain are developed and inculcated methods of artificial embolization vessels. Under the roentgenologic control under a bleeding vessel a catheter is conducted, and on him — embols, closing the road clearance of vessel, than stop of bleeding is achieved. As embols marbles are used from synthetic polymeric materials (silicon, polistirol), gelatin. In the place of embolization in subsequent there is formation of blood clot.

Basic testimony to imposition of vascular stitch — necessity of renewal of ability to travel cross-country of main arteries. A vascular stitch must be highly impermeable and answer the following requirements: he must not violate the current of blood (absence of narrowing and turbulence); in the road clearance of vessel how possible less stitch material must be found. Distinguish the stitch of hand and mechanical.

By a hand a vascular stitch is laid on by atraumatic needles. Ideal connection of vessel is considered end in an end. A circular vascular stitch can be imposed by tantalum paper clips, rings of Donetsky. A mechanical stitch is enough accomplished and not narrowed road clearance of vessel.

A regional vascular stitch is laid on at the tangent wound of vessel. After imposition a stitch is strengthened by fascia or muscle.

At presence of large defect in, appearing as a result wounds or operations (for example, after deleting of tumour), a wall, patches are applied from biological material (fascia, wall of vein, muscle). More frequent choose autovein (large hypodermic vein of thigh or superficial vein of forearm).

As transplants in surgery of vessels use auto- and allotransplants arteries or veins, prosthetic appliances are widely applied from synthetic materials. A reconstruction is produced by imposition of anastomosis end in an end or sewing of transplant.

Physical methods. The thermal methods of stop of bleeding are based on property of high temperatures to roll up albumens and on power of low temperatures to cause the spasm of vessels. These methods acquire the large value for the fight against bleeding during the operation. At the diffuse bleeding from a bone wound to her the serviettes saturated with hot isotonic solution of chloride of sodium are put. Appendix of ice-bag at hypodermic hematomas, swallowing of pieces of ice at the gastric bleeding are widely used in surgery.

Diatermocoagulation, based on application of alternating current of high-frequency, - basic thermal method of stop of bleeding. He is widely used for bleeding from the damaged vessels of hypodermic fatty cellulose, muscle, shallow vessels of brain. Basic condition of application of diatermocoagulation — dryness of wound, and during its conducting it does not follow to take fabric to charring because it in itself can cause bleeding.

A laser (focused as a bunch electronic radiation) is applied for the stop of bleeding at patients with the gastric bleeding (ulcer), at persons with haemophilia, at the oncologic operations.

Cryosurgery — surgical methods of medical treatment with local application of cold: at the operations on richly vessely organs (brain, liver, buds), especially at deleting of tumours. The local freezing of fabric can be produced without some damage of healthy cages surrounding the area of cryonecrosis.

Chemical and biological methods. The styptic matters divide by facilities of resorptive and local action. Resorptive action develops at the receipt the matters in a blood, local — at direct his contact with raw fabrics.

The hemostatic matters of common resorptive action are widely used for the internal bleeding. Most effectively direct blood transfusion, expediently also as-grown canned blood transfusion by small doses (100-150 ml), plasma, trombocyte mass, fibrinogen, protrombine complex, antihemofilic globulin, cryoprecipitate and other. These preparations are showy at bleeding related to innate or second insufficiency of separate factors of rolling up of blood at the row of diseases (sickle-cell anemia, leucosis, haemophilia and other).

Ingibitor of fibrinolisis, possessing power to lower fibrinolitic activity of blood, are widely used presently. Bleeding, associate with the rise to the last, are observed at the operations on lights, heart, prostatic gland, at the cirrhosis of liver, septic states, at transfusion of large doses of blood. Are used both biological antifibrinolitic preparations (trasilol, kontrikal), and synthetic (ε-aminocapronic acid, amben).

Dicinon, etamzilat — preparations accelerating formation of tromboplastin, they normalize permeability of vascular wall, microcirculation is improved. As facilities normalizing permeability of vascular wall, apply routines, ascorbic acid, karbazochrome.

Vikasol — the synthetic water-soluble analogue of vitamin the K. How remedy is used for bleeding related to lowering of maintenance in the blood of protrombine. It is shown at sharp hepatitis obturation icterus, parenchymatous and capillary bleeding after the wounds and surgical interferences, at the gastrointestinal bleeding, ulcerous illness, haemorrhoidal and protracted nose-bleeds.

For the process of transformation of protrombine in trombin very a few of ions of calcium, which usually are already present in a blood, is needed. Therefore application of preparations of calcium as a styptic agent expediently only in the case of transfusion of massive doses of citrate blood, because at co-operation of calcium with citrate the last loses the anticoagulation properties.

The hemostatic matters of local action are widely used. At the parenchymatous bleeding from a wound the livers apply an original biological tampon – muscle fabric or stuffing-box as a free shred or shred up and about. The special value in surgery has application of fibrin tape, biological antiseptic tampon, haemostatic collagen sponge. Haemostatic and gelatinous sponges, use a biological antiseptic tampon for the stop of capillary and parenchymatous bleeding from bones, muscles, parenchymatous organs, for the tampon sines of hard brain-tunic.

Trombin — the preparation got from plasma of blood of donors, is instrumental in transition of fibrinogen in a fibrin. Preparation is effective at capillary and parenchymatous bleeding of a different origin. Before the use he is dissolved in isotonic solution of chloride of sodium. With solution of preparation sterile gauze serviettes or haemostatic sponge, which lay on a bleeding surface, are saturated. Contra-indicated application of trombin at bleeding from large vessels, because it is possible development of widespread thromboses with a mortal end.

The combined methods. For strengthening of action of hemostasis different ways of stop of bleeding are sometimes combined. Are most widespread shrouding by muscle fabric or greasing by glue of vascular stitch, simultaneous application at the parenchymatous bleeding of a different type of stitches, biological tampons and other.

For medical treatment of patients with DIС-syndrome the removal of causing him reason, the circulatory blood volume renewal, conducting of measures on liquidation of kidney insufficiency, and also normalization of hemostasis are important – introduction of heparin and (stream) native or fresh-frozen plasma, trombocyte mass; if necessary apply artifitial ventilation of lungs.

For the stop of bleeding caused by action of medicinal by preparation use native or fresh-frozen plasma, at the overdose of anticoagulants of indirect action – vikasol (vitamin K), at an overdose of heparin protamina sulfate, for inactivation fibrinolitic preparations – ε-aminocapronic acid, trasilol.

For the stop of bleeding at patients with haemophilia apply cryoprecipitate and antihaemofilic plasma, native plasma, native donor plasma, fresh citrate blood, direct blood transfusions.