Остается открытым и актуальным вопрос изменений маркеров метаболизма эритроцитов исходя из патогенетических особенностей течения травматической болезни при политравме. Целью данного исследования явилось изучение функционального состояния эритроцитов в условиях развития гипоксии смешанного генеза у больных травматической болезнью. Для этого было проведено проспективное рандомизированное контролируемое клиническое исследование 120 пациентов на базе отделения политравмы. В крови определяли основные маркеры функционального состояния эритроцитов – лактат, пируват, 2,3-ДФГ, АТФ спектрофотометрическим. Выявлено то, что течение острого и раннего периодов травматической болезни сопровождается изменениями функционального состояния эритроцитов, о чем свидетельствуют снижение уровня АТФ и увеличение уровней лактата, 2,3-ДФГ, индекса лактат/пируват в остром периоде. Установлена связь между маркерами функционального состояния эритроцитов в момент поступления и развитием инфекционно-воспалительных осложнений, постгеморрагической анемии, посттравматической нефропатии.
Background. Enteral insufficiency syndrome is a complicated and multifactorial symptom complex that is accompanied with impaired functions of the gastrointestinal tract and is also one of the main causes of the development of endotoxicosis, systemic inflammatory response syndrome, abdominal sepsis, septic shock, and multi-organ failure. Thrombosis, which is associated with oncological diseases, is another common cause of death among patients with cancer after the progression of the disease. Development and implementation of new methods of detoxification in cancer patients in clinical practice after multi-organ surgeries is a major problem in intensive care. Purpose – to study the effectiveness of the enteral administration of sodium hypochlorite in cancer patients after multi-organ surgeries with systemic inflammatory response syndrome and to monitor the dynamics of certain markers of inflammation. Materials and methods. 53 patients with cancer were observed after having undergone multi-organ surgeries on the abdominal organs. The patients were divided into two groups: the main group (n=27), in which indirect electrochemical detoxification with sodium hypochlorite at a concentration of 0,06% was carried out by the drip infusion method through a gastrointestinal tube, and the comparison group (n=26), in which the treatment was performed according to standard treatment regimens. The examination was carried out at 3 stages – before NaClO infusion, on the 1st and the 7th day after the indirect electrochemical detoxification. Groups were compared according to age and anatomical and functional zones of the surgery (the surgery was performed on the abdominal organs). Results. Patients with stage 2/3 enteral insufficiency syndrome were treated with the method of electrochemical detoxification with sodium hypochlorite, which led to the inflammation reduction and normalization of the hemostatic system parameters. In patients, who were receiving sodium hypochlorite (the main group), the reduction in inflammatory mediators was observed: C-reactive protein (CRP) – from 22.1 to 5.6 mg/l, interleukin-6 (IL-6) – from 14,36 to 1.55 pg/ml, and also hemostatic parameters were improved. A decrease in the international normalized ratio (INR), fibrin, activated partial thromboplastin time (APTT), D-dimer level, blood clotting time, and an increase in prothrombin index were observed. Analyzing the effectiveness, it should be noted that the correction of the hemostatic system and the development of inflammation are significantly faster (on the 1st day after the NaClO infusion) compared with standard treatment methods while also ensuring plasma preservation. Conclusions. The use of the method of electrochemical detoxification with 0,06% NaClO in postoperative intensive therapy in enteral insufficiency syndrome prevents the development of systemic inflammation and hypocoagulation. The inclusion of sodium hypochlorite in the complex postoperative therapy during the day allowed the development of inflammation (a decrease in the expression of IL-6 and CRP) to be halted and procoagulative changes (a decrease in INR, fibrin, APTT, D-dimer level, blood clotting time, and an increase in prothrombin index) to be achieved.
Introduction. Enteral insufficiency syndrome accompanies the development of many acute diseases of the abdominal cavity. According to statistics, as a result of advanced and multi-organ surgery in oncosurgery for 2019–2020, enteral insufficiency was a complication in 39 % of all cases, regardless of anatomical and physiological area, and complications such as hepatorenal syndrome – in 50–80 % cases. The aim of the work is to study the effectiveness of correction of hepatorenal syndrome on the background of enteral insufficiency in cancer patients after multiorgan surgery. To do this, we used the method of indirect electrochemical detoxification with a solution of sodium hypochlorite. Materials and methods. 71 patients with oncopathology who underwent multiorgan surgery in different anatomical and physiological areas were examined. Patients were divided into two groups: the main group (n = 36), in which indirect electrochemical detoxification was performed with sodium hypochlorite solution at a concentration of 0.03 ; the comparison group (n = 35) – treatment was carried out according to standard schemes. The groups were compared by age and anatomical and physiological areas that were operated on (surgery was performed on the chest and mediastinum and abdominal organs). Results and discussion. For the treatment of patients with enteral insufficiency used the method of electrochemical detoxification with sodium hypochlorite, which reduces the indicators that reflect blood toxicity and the degree of intoxication. This was evidenced by a decrease in the concentration of bilirubin by 23.1 %, urea by 20.6 %, creatinine by 23.4 %, ALT by 57.2 % alkaline phosphatase by 69.5 %. When using this method for the third day managed to get a detoxifying effect. Conclusions. The expediency of including sodium hypochlorite in the complex postoperative therapy is shown. This is proved by the results of a comprehensive study of cancer patients after multiorgan surgery with the development of hepatorenal syndrome on the background of enteral insufficiency. It was found that the use of infusions of 0.03 % NaClO solution has a detoxifying effect: significantly reduces elevated concentrations of bilirubin by 23.1 %, creatinine by 20.6 %, urea by 23.4 %, improves the rheological properties of the blood. Therefore, given the relatively low effectiveness of conservative and insufficient availability of surgical treatment along with high mortality, prevention of hepatorenal syndrome in patients with enteral insufficiency by indirect electrochemical detoxification can significantly reduce its incidence.
Objective of the research is to assess the likelihood of complications in the acute and early periods of Traumatic Disease (TD) and primary condition and reserve capability of hemodynamic and homeostasis in patients with polytrauma. Materials and methods. A retrospective study was carried out on 32 patients suffering from polytrauma. The group of the study included patients with the severity of injury according to the Injury Severity Score (ISS) more than 25 points and on a scale APACHE II 10-25 points at the time of admission. The estimated blood loss was 30-40% of blood volume (BV). The individual assessment of blood loss was calculated by Moor. Results. The study of 20 (62.5%) men, 12 (37.5%) women aged 18 to 60 years old (35.22 ± 12.66) were done. The mechanical ventilation was performed for 30 patients (93.75%), and 2 patients (6.25%) required oxygen therapy 5 lit per min for 3 days. The duration of mechanical ventilation was in 10 patients - up to 1 day, 8 patients - up to 3 days and at 12 - more than 3 days. Among 12 patients, who used AMV more than 3 days, 10 patients were tracheostomy in 3d day and 2 patients were extubated on 4th day. Among the patients examined thirty patients (93.7%) had posthemorrhagic anemia during first day of injury. Infectious complications like purulent tracheobronchitis and pneumonia were observed in 14 (43.75%) patients. The local infectious complications (abscesses, festering wounds) occurred in 5 (15.6%) patients and bedsores in 3 (9,375%) patients. The catheterization of the bladder lead to the development of urinary tract infection in 3 patients (9,3%). Conclusion. The most problematic category of victims includes patients with injuries several anatomical regions. Pneumonia, anemia, urinary tract infection and local infectious complications were considered as the most common complications of acute and early periods TD. The factors that influenced the probability of a high degree of complications were AMV, the thoracic component of the injury, more massive blood loss, long-term catheterization of the bladder.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.