Pacientul: Gavril Dorel, 46 ani din Suceava, Talia: 176 cm, Greutate: 94 kg Diagnosticul: Colecistit litia ic, Pancreatit

acut, Ciro !e"atic, virus C, Dia#et $a!arat insulino de"endent% &"era'ia "ro"us: Colecistectomie "e cale la"arosco"ic% Preo"erator: Pacient con(tient, coo"erant, a)e#ril, T%*% + 1,-./0mm1g, *%2% + /6#.min, 34G 5n limite normale, diure )i iologic% Paraclinic: amila a seric 1,16,7 7.8, alaniaminotrans)era a 1617.8, creatininemie -,9mg.dl, glicemie ,0-mg.dl, 1emoglo#ina 14,/ g.dl, 1ematocrit 4,9, eritrocite 4,9 mil%, leucocite 4,6mii, trom#ocite 1,-%---.:l, T; + 16sec%, "rocente de "rotrom#in 699, <=> 1,6 , *PTT 6-,9 sec% Tratament "reo"erator: Ce)tamil g,, Sco#util ),, *lgi)en ),, ?uamatel )l,, 41 ),, *s"ato)ort ),, reec!ili#rare !idroelectrolitic, tratamentul cu insulin com)orm sc!emei% Su# aneste ie general cu intu#a'ie orotra!eal, se "ractic colecistectomie "e cale la"arosco"ic, drena@, sonda@ ve ical% 3volu'ie intrao"eratorie )avora#il: T%*% + 1,-./0mm1g, *%2% + 70A/-#.min, diure "re ent% Bolnavul se trans)er 5n salon Posto"erator intu#at oroAtra!eal, ventilat mecanic S<C2 cu Di&, + 6-9, cu monitori are 34G, T*, S"&,, diure % En "osto"erator imediat, la 0 minute du" instalarea #olnavului 5n "at se constat o cdere tensional de la 1,-mm1g la 0/mm1g (i o cre(tere a *%2% de la /-#.min la 11-#.min% Tegumente (i mucoase "alide, eFtremit'i reci% Pacientul nu rs"unde la tratamentul administrat "entru reec!ili#rare: Ser )i iologic 0--ml, gelo)u ine 1---ml, 11C ,--mg% Se constat sGngerare "osto"eratorie, (oc !emoragic (i se solicit de urgen' consult c!irurgical% Se recoltea 18G de urgen': 1# + 7,0g.dl, trom#ocite 1-6---.:l, 1ematocrit ,1,99% Se decide reinterven'ia de urgen' cu aneste ie general <%&%T% <ntrao"erator se constat: 1emoragie "osto"eratorie din "eretele a#dominal Hvena om#ilicalI imediat du" colecistecomie "e cale la"arosco"ic% 1emo"eritoneu Ha"roF% JJlI, Koc !emoragic% Se "ractic !emosta , evacuarea !emo"eritoneului, lava@, drena@% <ntrao"erator se administrea 4 unit'i SGnge <ntegral, Ser )i iologic 1--ml, Gelo)usine 1--- ml% 3volu'ie intrao"eratorie )avora#il du" !emosta , ec!ili#rare !emodinamic (i corectarea anemiei%

Pacientul se trans)er 5n Posto"erator, sta#il !emodinamic cu diure "re ent, intu#at orotra!eal, ventilat mecanic S<C2, Di&, 6-9% 1emoleucograma recoltat imediat 5n "osto"erator relev: 1# + /g.dl, 1t + ,09, eritrocite ,,/mil. :l, trom#ocite 1-1%---. :l, T ;uick 17,7 sec%, "rocente de "rotrom#in 099, *PTT 66,4 sec%, <=> 1,00, glicemie 6,9,4 mg.dl% Se continu tratamentul "osto"erator cu: >eec!ili#rare !emodinamic, !idroelectrolitic (i tratamentul anemiei cu SGnge integral 17, C3> 17, P=C 07, macromolecule, anti#iotic, !emostatic, diuretic, insulin 5n administrare <%2%, continu, "e in@ectomat 47.!, analge ie% 3volu'ie "osto"eratorie )avora#il T%*% + 16-./-mm1g, *%2% + /0A9-#.min, diure "re ent% Bolnavul se detu#ea la , ore de la )inali area reinterven'iei% Con(tient, coo"erant% Prima i "osto"erator, evolu'ie )avora#il: "acient con(tient, coo"erant, sta#il !emodinamic cu diure "re ent, a)e#ril, drena@ a#dominal 4--ml serosangvinolent% *nali e: 1# + 9,/g.dl, 1t + ,/,/9, eritrocite 6,6mil. :l, leucocite 6,6 mii.:l, trom#ocite 99%---.:l, T ;uick 17,/ sec%, "rocente de "rotrom#in 099, *PTT 61,6 sec%, <=> 1,0, glicemie 101,4 mg.dl% Continu tratamentul "osto"erator: reec!ili#rare !emodinamic, !idroelectrolitic (i tratamentul anemiei, SGnge integral 17, P=C ,7, macromolecule, anti#iotic, !emostatic, diuretic, men'inerea glicemiei% * doua i "osto"erator, evolu'ie )avora#il: "acient con(tient, coo"erant, sta#il !emodinamic cu diure "re ent, a)e#ril, drena@ a#dominal 6--ml serosangvinolent% Continu tratamentul "osto"erator: reec!ili#rare !emodinamic (i !idroelectrolitic, macromolecule, anti#iotic, !emostatic, diuretic, men'inerea glicemiei% * treia i "osto"erator, evolu'ie )avora#il: "acient con(tient, coo"erant, sta#il !emodinamic cu diure "re ent, a)e#ril, drena@ a#dominal /--ml serosangvinolent% Continu tratamentul "osto"erator: reec!ili#rare !emodinamic, !idroelectrolitic (i tratamentul anemiei, P=C ,7, macromolecule, anti#iotic, !emostatic Hnovoseven )l /I, al#umin )l,, diuretic, men'inerea glicemiei% * "atra i "osto"erator, evolu'ie )avora#il: "acient con(tient, coo"erant, sta#il !emodinamic cu diure "re ent, a)e#ril, drena@ a#dominal 1,--ml cu as"ect de ascit% Tran it intestinal "re ent "entru ga e% *nali e: 1# + 1,,0g.dl, 1t + 66,,9, eritrocite 4,,mil. :l, leucocite 0,7 mii.:l, trom#ocite

1,6%---.:l, T ;uick 16,6 sec%, "rocente de "rotrom#in 609, *PTT 61,1 sec%, <=> 1,4, glicemie 199,, mg.dl, amila a seric ,07.l, creatininemie -,/ mg.dl, uree 14,,mg.dl, ionograma seric 5n limite normale% Continu tratamentul cu P=C ,7, *l#umin uman )l%,, reec!ili#rare !idroelectrolitic, anti#iotic, !emostatic, calmante, insulin su#cutan con)orm sc!emei% * cincea i "osto"erator evolu'ie )avora#il: "acient con(tient, coo"erant, sta#il !emodinamic cu diure "re ent, a)e#ril, drena@ a#dominal 6--ml cu as"ect de ascit% Tran it intestinal "re ent% Continu tratamentul cu P=C ,7, *l#umin uman )l%,, reec!ili#rare !idroelectrolitic, anti#iotic, !emostatic, calmante, insulin su#cutan con)orm sc!emei% * (asea i "osto"erator, "acientul se trans)er "e sec'ia C!irurgie General sta#il !emodinamic, a)e#ril cu diure "re ent, drena@ a#dominal ,--ml ascit, tran it intestinal "re ent unde va continua tratamentul con)orm D%&% En cursul tratamentului anemiei sAau )olosit: 6 7 SGnge integral, , 7 C%3%>% 14 7 P%=%C%, "entru !emosta sAau )olosit / )lacoane novoseven%