RESUMEN
OBJECTIVE: To establish the effectiveness of complex therapy with Remaxol in optimizing the early postoperative period and increasing the reparative ability of intestinal tissues in acute intestinal obstruction complicated by peritonitis. MATERIAL AND METHODS: We analyzed treatment outcomes in 37 patients with acute intestinal obstruction complicated by peritonitis. The control group included 19 patients who underwent standard therapeutic measures after resolving intestinal obstruction and resection of small or large intestine. The main group consisted of 18 patients who underwent intraoperative intestinal lavage with Remaxol through a probe and early postoperative intravenous infusions (800 ml within 2 days and 400 ml for subsequent 3 days). RESULTS: The main group was characterized by positive dynamics of clinical and laboratory parameters, in particular, relief of endogenous intoxication syndrome, reduction of oxidative stress and phospholipase activity, general hypoxia. Postoperative morbidity in the main group decreased by 61.7% (χ2=3.897, p<0.05). Better tissue healing in the area of intestinal anastomosis and laparotomy under Remaxol therapy was demonstrated. CONCLUSION: Inclusion of Remaxol in complex therapy of acute intestinal obstruction complicated by peritonitis can significantly improve treatment outcomes, reduce the number of complications and increase reparative potential of tissues. Positive effect of this drug is based on less oxidative stress, phospholipase activity and hypoxia.
Asunto(s)
Obstrucción Intestinal , Peritonitis , Humanos , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Enfermedad Aguda , Hipoxia , Peritonitis/complicaciones , Peritonitis/diagnóstico , Periodo Posoperatorio , FosfolipasasRESUMEN
OBJECTIVE: To determine the main trigger mechanisms of multiple organ failure in acute severe pancreatitis. MATERIAL AND METHODS: An experimental study included 26 dogs with pancreatic necrosis. We assessed homeostasis disorders and functional changes in the pancreas, bowel, liver, kidneys, lungs and heart. Forty-six patients with severe acute pancreatitis were examined. We studied homeostasis disorders and functional state of the organs, endotoxemia, lipid peroxidation, phospholipase activity, coagulation system and hypoxia. RESULTS: Injury of various organs and systems due to systemic inflammatory response at the early stage of disease is an important aspect in progression of acute pancreatitis. Membrane destabilizing phenomena and disturbances in tissue component of coagulation system are the most significant factors. Patients with severe acute pancreatitis had significant changes in homeostasis. We distinguished two subgroups of patients. The course of disease was different. In the first subgroup, changes in homeostatic parameters were 15.4-24.2% less than in the second subgroup. This largely determined treatment outcomes as a whole. In the first subgroup, therapy was effective in most cases, in the second one - less effective that required surgical interventions. In the first subgroup, mortality and hospital-stay were less compared to the second subgroup. CONCLUSION: Oxidative stress, hypoxia, activation of phospholipases, and coagulation abnormalities are important in the development of systemic inflammatory response syndrome following acute pancreatitis. These factors are triggers for a cascade of the same kind of pathophysiological phenomena contributing to multiple organ failure and pancreatitis. In the tissues of various organs, proportional growth of these markers is observed until the 6th day, while in the blood - until the 4th day.
Asunto(s)
Insuficiencia Multiorgánica , Pancreatitis Aguda Necrotizante , Síndrome de Respuesta Inflamatoria Sistémica , Animales , Progresión de la Enfermedad , Perros , Homeostasis , Humanos , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/fisiopatología , Pancreatitis Aguda Necrotizante/complicaciones , Pancreatitis Aguda Necrotizante/diagnóstico , Pancreatitis Aguda Necrotizante/fisiopatología , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Síndrome de Respuesta Inflamatoria Sistémica/fisiopatologíaRESUMEN
The effcacy of Remaxol was studied in the treatment of patients with acute biliary pancreatitis under clinical and laboratory con- ditions by the recommended indices, as well as by the markers of endogenous intoxication, the intensity of lipid peroxidation, activity of some enzymes and indicators of hypoxia. The use of Remaxol in the treatment of acute biliary pancreatitis was highly resultant in correction (prevention of progression) of the functional hepatic failure and homeostatic disorders as a whole. It was demonstrated that the hepatoprotective effect of the drug was based on its ability to reduce oxidative stress, to inhibit excessive phospholipase activity and to alleviate the signs of general hypoxia.