INFLUENCE OF ACUTE BLOOD LOSS ON THE FORM OF ERYTHROCYTES IN GASTROINTESTINAL BLEEDINGS

N.A.STRIJKOV, I.M.BAIBEKOV, R.A.IBADOV

Republican Specialized Center of Surgery named after acad. V.Vahidov, Tashkent, UZBEKISTAN

The deterioration of erythrocyte deformability in various pathological conditions, leads to the restriction of functions of oxygen transportation system at all its levels: heart, vascular bed, oxygen transporting function of the blood (Zverko V.L. et al; 1999; Gushin A.G. et al, 2000; Kameneva M.V., Undar A., ​​Antaki J.F. et al., 1999). The greatest influence is made on erythrocytes by the change of the constants of circulating blood especially conditioned by acute and massive blood loss (Goltsov A.N., Kadantsev V.N., 1995).

We have conducted a comparative study of the influence of acute blood loss on erythrocytes, as in clinical practice – in case of ulcer bleedings and their treatment. Changes in the form of erythrocytes were evaluated complexly by means of with SEM and EMTK.

Ulcer bleeding are accompanied by significant changes in the form of erythrocytes in peripheral blood. Normally, according to our data, obtained by means SEM, as well as EMTK, the main part of erythrocytes are discocytes. Echinocytes with one outgrowth 36.2 + 4.3, with a crests 58.1 + 6.1, with numerous outgrowths 36.9 + 6.7; stomatocytes (dome-like) 13.2 + 1.8; irreversible forms: Spherical 0.9 + 0.2, in the form of a flat ball 5.9 + 1.3, in the form of mulberry fruit 3.4 + 1.6 per 1000 erythrocytes.

In patients with bleeding ulcers the number of discocytes reduces, and the same number of degenerated increases 1.9 times. After stopping the bleeding in the traditional way further decrease in the number of discocytes, up to 652.1 + 28.2. Content of degenerated forms increases almost by 2.25 times and 42.5 + 6.2.

Comparative morphometric study of peripheral blood erythrocytes during ulcer bleedings with the help of SEM and EMTK showed that the results obtained with both methods do not differ from each other.

Given the availability of EMT it can be recommended as an alternative SEM in the study of the form of erythrocytes in normal and pathologic conditions for rapid analysis.

ENDOSCOPIC HEMOSTASIS

R.S. SULTANOVA, U.A. NASIBOVA, M.D. MAJIDOV, Z.N. SHAHABASOVA

RMC GV, Makhachkala, RUSSIA

Purpose: to assess the capacity and effectiveness of endoscopic hemostasis of bleeding gastroduodenal ulcers and prevention of the latter by injection of 1% hydrogen peroxide solution in the volume of 10-40 ml with 2 ml of 5% ascorbic acid, based on data of experimental studies.

Objectives: 1. to carry out experimental study of the mechanism of action of 1% hydrogen peroxide solution and 5% of ascorbic acid on reparative, free radical status and antioxidant protective background in tissues. 2. to compare the frequency of recurrences of ulcerative gastroduodenal bleedings in the hospital in various groups of patients with the use of conservative treatment with the injection of H2-histamine receptor blockers and antihelicobiotics, haemostatic and substitution therapy in combination with endoscopic hemostasis. 3. to optimize the method of endoscopic hemostasis and improve the results of endoscopic treatment of patients with acute ulcerative gastroduodenal bleeding in patients of elderly and old age with concomitant diseases, with high surgical and anesthetic risk.

Materials and methods: The study included 12 patients at elderly and old age with ulcerative gastroduodenal bleedings of various degrees of activity: 4 (33,3%) - FORREST 1, 8 (66,7%) - FORREST 2. The diameter of ulcer was not more than 1 cm. In all cases there was carried out and endoscopic hemostasis by means of gastroduodenoscopy; through the biopsy channel of gastroduodenoscope there was introduced an injector and 10-40 ml of 1% hydrogen peroxide solution with 2 ml of 5% ascorbic acid was injected into the submucous area next to the source of bleeding. The comparison group consisted of 16 patients of old and elderly age, who were conducted conservative therapy with the introduction of H2-histamine receptor blockers and antihelicobiotics, and haemostatic and replacement therapy after gastroduodenoscopy. All patients were under control within the next 2 years.

Results: Injection of 10-40 ml of 1% hydrogen peroxide solution and 2 ml of 5% ascorbic acid into the submucosal area allowed to arrest bleeding in 100% of cases. The observed pattern is characterized by the fact that the mucosa at the injection site raises, becomes bright pink,

1% solution of hydrogen peroxide injected into the submucosal area along the periphery of ulcerative defect leads to the rapid decomposition of hydrogen peroxide with the release of peroxide oxygen and saturation of the interstitial spaces by it, creates a zone of high pressure, which results in compression of a bleeding vessel and rapid arrest of bleeding. The presence of excess oxygen reduces tissue hypoxia in the area of ​​bleeding, and prevents the formation of new mucosal defects at the site injection of the solution. In the main group primary hemostasis was achieved in 15 (93.8%) cases. After 9 hours of endoscopic control in 8 (66.7%) of the control group, the bottom of the ulcer was covered with fibrin, no bleeding was observed, at the site of injection of the solution, the mucous membrane was unchanged, 4 (33.3%) - had a red clot at the bottom of the ulcer; for the purposes of prevention of haemostasis there was conducted a repeated submucosal injection of haemostatic solution of the same volume, after 10-11 hours at the bottom of the ulcer there was observed fibrin. Over the next 2 years of observation, no cases of repeated hospitalization were revealed in the control group, however in the main group there were observed 8 (50%) cases of repeated hospitalization with recurrent bleeding. No fatal outcomes were observed in the compared groups.

Conclusion: This method of endoscopic hemostasis, conducted jointly with comprehensive medical treatment of ulcerative gastroduodenal bleedings by the injection of 1% hydrogen peroxide solution and 5% ascorbic conducted in conjunction with conservative treatment, is an effective method of stopping bleeding, prevention of recurrent bleeding and in the topical treatment ulcers, accelerates healing processes.

Date: 2014-12-28; view: 851