Background. Enteral insufficiency syndrome accompanies the development of many acute diseases of the abdominal cavity. According to the statistics, advanced and multi-organ surgical intervention in oncosurgery within the period from 2019 to 2020 resulted in enteral insufficiency being a complication in 39% of all cases, regardless of anatomical and physiological area, while complications in the form of endogenous intoxication syndrome made up 68% of cases. Purpose – studying the effectiveness of treatment of enteral insufficiency syndrome in cancer patients after multiorgan surgery with severe endogenous intoxication by means of indirect electrochemical detoxification with sodium hypochlorite solution. Materials and methods. The study involved 71 cancer patients who underwent multi-organ surgery on different anatomical and physiological areas. The patients were divided into 2 groups: treatment group (n=36) provided with indirect electrochemical detoxification by means of sodium hypochlorite solution at a concentration of 0.06%, comparison group (n=35) undergoing treatment according to standard schemes. The groups were comparable in age and anatomical and physiological areas that were operated on (surgery was performed on the chest and mediastinum as well as abdominal organs). Results. The method of electrochemical detoxification with sodium hypochlorite reducing the indicators that reflect blood toxicity and intoxication level was used for treating patients with enteral insufficiency. This was evidenced by decreased concentration of bilirubin by 23.1%, urea by 91.6%, creatinine by 99.4%, LII (leukocytal intoxication index) by 47.2% and procalcitonin by 68.2%. Being applied this method has made it possible to achieve a detoxifying effect early on day one. Conclusions. The findings of complete physical examination of cancer patients after multiorgan surgery with severe endogenous intoxication have shown a practical significance of sodium hypochlorite being included in comprehensive post-surgery treatment in enteral insufficiency syndrome cases. Infusions of 0.06% NaClO solution within 24 hours have been proved to provide a detoxifying effect: they significantly reduce elevated concentrations of bilirubin, creatinine, urea, LII and improve blood rheology. Administering sodium hypochlorite in the suppre-ssion of antioxidant defense mechanisms leads to the activation of oxidative processes. Including sodium hypochlorite in comprehensive post-surgery treatment in enteric insufficiency syndrome has shown a high efficiency.
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.
Purpose. To determine the features of intensive care of enteral insufficiency syndrome (EIS) in cancer patients after multiorgan surgery. Materials and methods. The work is based on the analysis of data from the literature and the survey of 36 cancer patients who underwent multiorgan thoracic, abdominal, retroperitoneal operative interventions. The severity of patients’ status was assessed using SOFA scale depending on the stage of ESI. The qualitative and quantitative composition of the bacterial flora of intestinal contents was studied. Results. The increase in number of advanced and multi-organ surgery in cancer treatment can be noted. Statistical data showed that in 2018–2019 operative interventions on the chest organs comprised 47 %, and on abdominal cavity — 51 %. Regardless of the localization of surgery on various anatomical and physiological sites, the enteral insufficiency manifests in 39 % of all surgical interventions. The mortality rate due to enteral insufficiency is about 46 %, and SPOI complications are noted in 78 % of cases. Compensated and subcompensated EI in the postoperative period occurs in 95 %. A new method of electrochemical detoxication using sodium hypochlorite was suggested for EI patients treatment in order to reduce the indices of their pathogenic gut microbocenosis. This method allowed to decrease the yield of E. сoli by 57,5 %, Enterococcus faecalis — by 72,3 % during the first day. At the end of study the yield of Staphilococcus xylosus dropped by 84,3 %, Candida lusitaniae and Candida spp. — by 98,3 %. Enterobacter aggomerans was reduced by 50,4 %, Staphilococcus haemolyticus and St. aureus — by 56,8 %. Conclusions. Treatment of patients with SEI allowed to decrease the rate of complications 1.4 times, the treatment time in intensive care departmet was shortened 1.7 times, treatment costs were reduced 2.4 times. Thus, it seems reasonable to pay more attention to the enteral insufficiency, particlualrly to disturbances of microbiocenosis as a marker of septic complications, in routine clinical practice.
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