APPLICATION OF SYNTHETIC SACK AND COAL-MINERAL-5 ADSORBENT MADE OF POLYVINYLPYRROLIDONE SHEET IN THE COMPLEX TREATMENT OF DISSEMINATED PURULENT PERITONITIS

E.A. ALIYEVA

Scientific Center of Surgery after named akad. M,A,Topchubashev, Baku, AZERBAIJAN

In order to completely exclude pathogenic microorganisms from abdominal cavity and small intestine we developed new sanation and drainage method of abdominal cavity and expreminentally aprobated it: this method allows decrease the typical shortcomings and problems observed following the operation. To this end, at our order, experimental production special constructor technology bureau on complex raw material processing of National Academy of Sciences of Azerbaijan produced synthetic 5 gram “sacks” made of polyvinylpyrrolidone sheet for injection and disposal of antiseptic solutions and antibiotics with upper and lower micro irrigators. Oil-Chemistry STI of Academy of Sciences of Azerbaijan produced local coal mineral UM-5 adsorbet for small intestinal detoxication. Bacteorogical studies, exudates received from abdominal cavity, examination results of washing solution of “sack” and small intestine chemical mustache of small intestine show that the bacterial dirtiness of exudates emited from the abdominal cavity in the main group decreased in the first 24 hours: Intestinal sticks decreased 16.7% (6.0% compared to trial group) compared to 24 hour peritonitis; streptococcus, staphylococcus, proteus enterobacteria, chlostrides, bacterioids also decreased. In the 14^th day, the bacteorogical study of sack washing solution did not reveal any bacterias. Though some decrease was observed in control group, but still aerobic microflora connected with anaerobic microflora was revealed in the abdominal cavity. This, in turn, causes continuation of microorganisms’and its toxins’ impact on peritonitis and absorbsion into general blood. The results of conducted experiments provide ground to apply the method to the peritonitis patients in the clinics. Clinical part of studies is based on the results derived from the treatment of 30 peritonitis patients. 15 of them constituted main and 15 constituted control group. Both groups had 9 patients with peritonitis of appendicitis origin and 6 patients with peritonitis after the operation. Lethality indicator of main group was proved to be 2.5 times lower than of control group. Suggested method proves that maximum exculision of pathogen microorganisms and their toxins from abdominal cavity and small intestine is possible and this prevents regeneration process, interintestinal abscess, activates the whole immune system, and improves the indicators of all studied analyses.

INTRA-ABDOMINAL HYPERTENSION WITH WIDESPREAD PERITONITIS

B.K. ALTIYEV, J.I. JABBAROV

Republican scientific center for emergency medical care, Tashkent, UZBEKISTAN

The aim of our study was to improve the results of surgical treatment of widespread peritonitis of different etiology by means of correction of intra-abdominal hypertension.

Materials and methods of study: The work is based on the study of results of treatment in 112 patients (67 men, 45 women) operated for widespread peritonitis from 2005 to 2010 in the department of emergency surgery of the RSCUMA. All the patients we were divided into 2 groups. The first (control) group included 52 patients that received postoperative conventional therapy.

The second group (main) consisted of 60 patients, in whom, complex intensive therapy included: nasogastrointestinal intubation of the intestine, and gastrointestinal lavage, activated gastroenterosorbtion with activated carbon, peridural analgesia, application of antihypoxants (sodium hydroxybutyrate, actovegin). Also, patients with of the main group were left laparoports, for the conduct of sanation laparoscopy, they were also measured IAP in dynamics on the 1,3,5 and 7 days after surgery. The degree of increase of intra-abdominal pressure or hypertension (IAH) were assessed according to the protocol of the World Congress on SAC (Australia 2004) - first, second, third and fourth degrees.

Results of the study and their discussion: On the first day after surgery, intra-abdominal pressure in patients of all groups was 15,2 ± 0,9 mm m.c., which corresponds to the 1^st degree of IAH. On the third day, improvement of indicators of IAP was observed in the main group of patients - 12,2 ± 0,2 mm of m.c., in 50 patients of the group we managed to prevent beginning gastrointestinal paresis and resolve it within 18 hours. In the patients of the control group, paresis was eliminated within 48 hours. Moreover, in the patients of the second group, prolonged APV for respiratory support within 5 hours was conducted less than in patients of the first group. Consequently, in the main group, pneumonia developed in 4 patients (6.7%), and in the control group - in 16 (30 , 8%) patients. In the patients of the control group multiple organ disorders developed in 14 (26.7%) cases. Fatal outcomes in the main group were observed in 4 (6.7%) patients, while such outcome in the control group was observed in 14 (26.9%) patients. In this case, average length of stay in hospital constituted 10,2 ± 0,61 days in the main group and - 14,7 ± 0,75 days in the control group.

Thus, timely use of postoperative IAP monitoring in patients with widespread peritonitis of various etiology allowed to prevent the development of organ disorder, reduce the development of suppurative and septic complications and postoperative fatal outcomes.

Date: 2014-12-28; view: 842