Maintenance of effective pulmonary gas exchange is obligatory, but not the only condition for the prevention of hypoxia. It is important to prevent violations of the transport of oxygen by blood. In the complex of measures aimed at eliminating or significantly reducing these disorders, combating blood loss (careful phased hemostasis, anatomical operation) and timely correction of the volume and composition of circulating blood occupy a key place.

The composition of infusion therapy may be different, but it must always comply with the natural mechanisms to compensate for blood loss and be ahead of it in pace and volume. This approach involves the use of hemodilution, to create which immediately after the patient enters the operating room, 400 ml of 10% glucose solution with 20 U of insulin, 1 ml of corglycon and 20 ml of panangin, 400 ml of polyglucin and 500 ml of native plasma are injected intravenously. The infusion rate should provide an introduction to the beginning of the operation of 10 ml of solutions per 1 kg of patient weight.

Further, the rate of infusion depends on the amount of blood loss, which on average

with extended and combined resections of the lung, it weighs 1.2 liters, or about 20% of the circulating blood volume. The most reliable and the only widely available method for determining the amount of blood loss during an operation is by weight. Periodic weighing of the dressing material moistened with blood allows changing the speed of infusions in a timely manner, preventing the development of episodes of hypovolemia. The total volume of infusions is usually 130—% of the volume of blood loss, while in most patients the need for transfusion of erythrocyte-containing components of donor blood does not occur, and hematocrit during the operation is 0.25—, 30 l / l.

It is known that such a degree of hemodilution does not have a significant effect on the oxygen supply of the organism; however, the majority of infusion-transfusion programs of the operative period so far include blood transfusion. Globular volume replacement is usually started at the end of the operation or in the coming hours after its completion, that is, at the time when the external respiration system (namely, the lungs are the first “target” for all transfused media) is maximally included in urgent compensatory processes, is under extreme load and turns out to be the least protected.

This circumstance is rarely taken into account in everyday practice, but it is precisely this that determines the low effectiveness and real danger of such “planned” blood transfusions. At the same time, in patients operated on the lungs, blood transfusions most often cause serious disturbances in the function of external respiration — prolonged hypoxemia, an increase in the amount of sputum, a distinct decrease in compliance of the lung tissue, and a slowdown in the process of expanding the perirovana lung. . Pulmonary capillary embolism with microbunches of canned blood, the formation of leukocyte antibodies and the release of leukocytes and platelets from biologically active substances that damage the endothelium of the pulmonary vessels, is accompanied by an increase in the permeability of the alveolar-capillary membrane and leads to interstitial edema and progressive compaction of the lung tissue. Impaired ventilation-perfusion ratio, hypertension in the remaining microcirculation zones, an increase in general pulmonary arterial resistance and stress on the right heart leads ultimately to a deterioration of pulmonary gas exchange, restriction of oxygen delivery to the tissues, progression of cardiopulmonary insufficiency, and an increase in the frequency of postoperative complications. Exclusion of whole blood from the composition of transfusion mediatransfusion of fresh washed erythrocytes, the use of microfilters makes it possible to reduce, but not exclude, the likelihood of the development of post-transfusion respiratory failure. Therefore, any transfusions of erythrocyte-containing media carried out in order to increase the oxygen capacity of the blood without taking into account the state of the entire oxygen-transport system as a whole and its other subsystems should be considered not only erroneous, but also dangerous. In our opinion, blood transfusion is shown only when it can improve the delivery of oxygen to the tissues or ensure its transport with less stress of compensatory mechanisms. Accordingly, the indications for transfusion of erythrocyte-containing media should be determined by investigating not only the Nvili concentration of hematocrit, but also calculating the quantitative value of oxygen transport. Blood transfusion is indicated if, at a HB concentration of less than 100 g / l, oxygen transport under conditions of normolemia decreases to 350 ml / min * m2. However, even in this situation, there is a high risk of numerous post-transfusion complications, since canned donor blood is always an alien and defective tissue and cannot adequately replace the main functions of the patient’s own blood. Therefore, in all cases,when blood transfusion is necessary, the best blood transfusion medium is the autologous blood components.