Study of Electrolyte Disorders as Criterion-Important Markers of Endogenous Intoxication in Patients With Anastomosis Leakege Against a Background of Resection of the Small Intestine

Abstract

Summary. The aim of the study was to study the dependence of ion exchange and saturation with iron transferrin on the background of increasing endotoxicosis, depending on the severity of the clinical course of acute small bowel obstruction and peritonitis.
 Materials and methods. The research was carried out at the SI «ZIGUS NAMSU» and was based on the analysis of laboratory data of 63 patients with a failure of small intestinal anastomoses who in the future needed one of the options of resections of the segments of the small intestine, which were treated in the clinic from 2016 to 2019. All patients were divided into 3 groups according to the degree of physical severity of the condition on the APACHE II scale. The study was conducted in two stages: the first stage examined the content of zinc, copper and iron ions in the serum of all patients studied, the second stage of the study in patients evaluated the objective indicators of endogenous intoxication on the basis of leukocyte index of intoxication, index of content molecular weight, malonic aldehyde and diene conjugates in serum and iron levels in whole blood, as well as its serum.
 Results and Discussion. The study of Fe2+, Zn2+, Cu2+ metabolism in the serum of all patients with inflammatory phenomena of the peritoneum on the background of anastomosis failure revealed significant changes. In the clinical group of patients with small bowel anastomosis, the level of zinc upon admission to the hospital was significantly increased. In the second stage, we conducted a study on the detection of an increase in serum iron content, endogenous intoxication and a decrease in transferrin iron saturation depending on the clinical course of the disease in patients with acute intestinal obstruction and peritonitis and the degree of contamination of the small intestine. The results shown in study indicate that in the studied patients, depending on the severity of the disease there is a progressive decrease in the content of iron in whole blood, along with an increase in its serum level against the background of a significant decrease in iron saturation and increase in objective indicators of endogenous intoxication.
 Conclusions. On the basis of the results of the research, we can conclude that the increase of serum iron content with simultaneous decrease of transferrin iron saturation in the studied patients on the background of intensification of endotoxicosis depending on the severity of the condition, considering it as a factor of increasing the aggressiveness of bacterial resistance and flora correlates with the severity of the clinical course, according to which appropriate adequate additional corrective therapy is performed in complex surgery. treatment of patients with a small bowel anastomosis.