The effectiveness of preoperative therapy and the portability of the subsequent operation is largely determined by the severity of volemic disorders, impaired water-electrolyte balance, protein metabolism, and the state of the oxygen capacity of the blood. Therefore, the correction of metabolic disorders and volemic disorders is one of the most important areas of preoperative preparation.
For patients with lung cancer is characterized by the development of a number of pathological disorders of homeostasis. Their occurrence is associated with the toxic effects of tumor metabolism products, metabolic and nutritional disorders, metastasis to the liver and bone marrow, recurrent bleeding, purulent intoxication associated with the development of paracancrosis inflammatory changes . In addition, they may be due to concomitant diseases and age-related changes.
Studies conducted by the clinic staff over the years have shown that characteristic for patients with lung cancer with an uncomplicated course of the disease is a non-sharp decrease in the volume of circulating blood by 10–15% of proper values, mainly due to the globular volume, and to a lesser extent – plasma volume (Bryusov PG, 1972). Hypoproteinemia, as a rule, is absent or expressed subtly . Characteristic is the tendency to hypoxia , the development of adrenal insufficiency . With uncomplicated disease in patients with lung cancer, there is only a moderate decrease in the main indicators of circulating erythrone. Significant inhibition of bone marrow hematopoietic function in preoperative period in these patients is not observed . Severe volemic disorders and metabolic disorders, as a rule, are associated with the development of a paracancic infection and concomitant intoxication, and are also observed in cancer cachexia in patients with generalization of the tumor process.
Correction of hypovolemia and hypoproteinemia with infusions of protein and plasma replacement solutions should be carried out with a circulating blood volume deficit of more than 10—% of the proper values, severe hypoproteinemia and globular volume deficit, which is mainly observed in patients with severe purulent intoxication that developed on the background of paracancrosis inflammatory changes. Polyionic glucose solutions with insulin, crystalloid solutions, dextrans are parenterally administered to detoxify and normalize water electrolyte disturbances, maintain the body’s energy balance. In the composition of the infusion media, potassium preparations are injected: potassium chloride (3– g), asparkam, and incolen. At the same time, a mandatory control of the dynamics of concentration and ECG indicators of potassium metabolism and the study of potassium lure is necessary.The presence of magnesium in optimal ratios with calcium in the composition of polyionic solutions provides a more complete correction of violations of the internal environment, taking into account, moreover, the effect on the patient’s bio-energy, injected glucose with insulin, stimulation of anabolic and plastic processes. In the complex of the therapy carried out include vitamins, according to indications they use hemostimulants, anabolic hormones.