Целью настоящей работы явилась оценка эффективности ремаксола в коррекции функционального состояния печени в раннем послеоперационном периоде после холецистэктомии у больных с повышенным риском поражения печени. Полученные результаты и их анализ свидетельствуют о существенном уменьшении нарушений функционального состояния печени, мембраностабилизирующем эффекте ремаксола на печеночные клетки. Применение ремаксола у больных в послеоперационном периоде позволило уменьшить количество билирубина относительно группы больных, получавших стандартное лечение, через 1 сут после операции на 11,22 % (p < 0,05), на 2 сут — на 12,71 % (p < 0,05), на 3 сут — на 22,14 % (p < 0,05), на 4 сут — на 20,11 % (p < 0,05) и на 5 сут — на 14,15 % (p < 0,05). Также отмечено уменьшение активности сывороточных аминотрансфераз: аланиновой — на 16,17 – 28,21 % (p < 0,05), аспарагиновой — на 7,25 – 12,02 % (p < 0,05). В свою очередь включение в комплексную послеоперационную терапию ремаксола позволило на 5 сут после операции нормализовать процессы перекисного окисления липидов, что не наблюдалось у больных в группе сравнения.
В хронических экспериментах на собаках с прогрессирующим каловым перитонитом изучали влияние ремаксола на развитие эндогенной интоксикации и детоксикационную способность печени. Показано, что ремаксол сохраняет резистентность печени к действию продуктов перекисного окисления липидов и активизации фосфолипаз. Высказано предположение о возможности включения ремаксола в перечень лекарственных препаратов, применяемых при остром перитоните с целью поддержания функционального состояния печени.
AIM OF STUDY To develop a method for assessing the severity of obstructive jaundice (OJ) of non-neoplastic orogin on the basis of functional parameters of the liver and the activity of pathogenetic agents of hepatodepression.MATERIAL AND METHODS Clinical and laboratory studies of 142 patients with breast cancer of non-tumor origin. The indicators of the functional state of the liver, the index of plasma toxicity for albumin, and the content of malondialdehyde (MDA) were evaluated.RESUlTS Based on the assessment of a number of blood parameters - the content of total bilirubin (TB), the plasma toxicity index for albumin, the MDA level — the severity index of obstructive jaundice of non-neoplastic origin (SIOJ) was developed:SIOJ = IT1/ITn + TB1/TB + 5(MDA1/MDAn)where IT 1 is the plasma albumin toxicity index at the current moment, ITn is the normal albumin plasma toxicity index, TB1 is the current bilirubin content, TBn is the normal bilirubin content, MDA1 is the current malondialdehyde content, MDAn is the normal value. The index less than 13 indicates a mild severity, 14–21 is moderate severity, 22 and higher indicates a severe degree of OJ. The method increases the objectivity of determining the severity of non-neoplastic origin by establishing the severity of liver damage and the processes underlying it.CONClUSiON The suggested clinical and laboratory index allows the severity of obstructive jaundice to be objectively and quickly determined upon admission of a patient to the hospital and also adequate therapy to be initiated in case of severe degree for anticipation of possible post-operative complications, so the treatment should be focused on managing triggers of hepatodepression. The method is simple and available in medical institutions of various levels. The method is especially valuable when used in the dynamics of the early postoperative period.
Изучены фармакологические эффекты ремаксола у пациентов с хроническим пародонтитом тяжелой степени. Установлено, что при включении ремаксола (400 мл в сутки внутривенно капельно) в комплексную терапию хронического генерализованного пародонтита к 10 сут лечения отмечается улучшение клинических индексных показателей состояния пародонта в среднем на (23,96 %, p < 0,05) и субъективных ощущений пациентов. Показана эффективность включения ремаксола в стандартную терапию у пациентов с хроническим пародонтитом тяжелой степени, что отражается в снижении интенсивности свободнорадикальных процессов окисления в плазме крови (по данным хемилюминесценции в среднем на 27,4 %, p < 0,05) и уменьшении выраженности интоксикационного синдрома (по индексу токсичности плазмы крови на 25,7 % (p < 0,05). Эффективность апробируемой схемы терапии в коррекции воспалительных явлений в тканях пародонта у пациентов с тяжелым хроническим пародонтитом сопряжена с купированием интоксикационного синдрома и коррекцией системных проявлений окислительного стресса (r = 0,73 – 0,97).
The severity of endotoxemia in peritonitis depends on morphofunctional state of the intestine determined by the intensity of free-radical lipid peroxidation and phospholipase A 2 activity, which are the highest on day 1 postoperation. Key Words: endotoxemia; intestine; microcirculation; lipid peroxidation; phospholipase A 2Endogenous intoxication accompanies various diseases including peritonitis. In spite of high efficiency of drug therapy and elaboration of new surgical procedures, peritonitis is still the main cause for postoperation mortality [1,2,6]. Severe intoxication is the chief cause of death from acute peritonitis [3,6,7]. Dysfunction of the gastrointestinal tract contributes to the development of endotoxemia during peritonitis [5]. However, the relationship between endotoxemia and changes in the morphofunctional state of the intestine caused by peritonitis and free-radical lipid peroxidation (LPO) and phospholipase A 2 (PLA2) activity remains unclear [4,8]. MATERIALS AND METHODSExperiments were performed on 24 adult dogs. The animals were narcotized with 0.04 g/kg sodium thiopental and intraperitoneally injected with 20% fecal suspension (0.5 ml/kg). Laparotomy, revision of the abdominal cavity, intestinal biopsy, and blood sampling from subcutaneous and mesenteric veins were performed on the next day under anesthesia. Repeated laparotomy, intestinal biopsy, and blood sampling were conducted on days 1, 3, and 5 postoperation. During Department of Surgery, N. P. Ogarev Mordvinian State University, Saransk the postoperative period, the animals received antibacterial and infusion therapy.The redox potential (RP) was measured using an EV-74 universal ionometer. Changes in the blood-tissue permeability were evaluated by capillary filtration and protein loss. The total and effective concentrations of albumin in the plasma were measured fluorometrically using an AKL-01 analyzer (Zond). The content of medium-weight molecules (MWM) was estimated spectrophotometrically on a SF-46 spectrophotometer at 280 nm. PLA z activity was measured in 10 mM Tris-HC1 buffer (pH 8.0) containing 150 mM Triton X-100, 10 mM CaCI:, and 1.2 mM yolk phosphatidylcholine as the substrate. The catalytic activity was estimated potentiometrically by the formation of free fatty acids. The contents of conjugated dienes and trienes in lipids were determined spectrophotometrically at 233 and 275 nm, respectively. The concentration of malonic dialdehyde (MDA) was estimated by the reaction with thiobarbituric acid (TBA). The preparations stained with hematoxylin and eosin were examined microscopically.
In order to find informative statically significant laboratory criteria for endotoxicosis in the diagnosis of acute renal injury, a clinical and biochemical study of 40 patients with acute renal injury developed against the background of renal urological and extrarenal surgical pathology was conducted. The results of the study demonstrate pronounced changes in the mechanisms of antioxidant protection that develop in patients with acute renal injury. Deviations from the initial level of the studied criteria are interrelated with many links of pathogenesis, where one of the central links is ischemia of the renal parenchyma. The progression of endogenous intoxication, taking into account the data obtained, confirmed by a decrease in prooxidant protection contributes to the progression of intrarenal changes, aggravating functional changes in renal and extrarenal injuries. Key words: significance of endotoxicosis criteria, acute renal injury, endotoxicosis, serum creatinine, glomerular filtration rate.
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