CYTOARCHITECTURE OF THE RED PART OF THE PERIPHERAL BLOOD IN PATIENTS WITH MULTIPLE ORGAN FAILURE AND SEPSIS

R.A. IBADOV, I.M. BAYBEKOV, N.A. STRIJKOV, N.R. GIZATULINA

Republican Specialized Centre of Surgery named after acad. V. Vakhidov, Tashkent,

UZBEKISTAN

In the modern methodology of multiparametric diagnosis of multiple organ failure (MOF) and sepsis, technologies of laboratory analysis are given a priority role. Optimization of oxygen transport under conditions of increased consumption, characteristic for severe sepsis and septic shock is the basis for successful treatment. Properties of erythrocytes are in direct relation with their form, the membrane which is quite sensitive to changes in the concentration of toxic substances, appearing in the blood during MOF and sepsis.

Purpose: To examine the state of forms of erythrocytes in patients with MOF and sepsis.

Material and methods: Capillary blood by express-method of ‘thick blood film” (EMTBF) - Patent РУз №DGU 01195, was studied in 27 patients with sepsis and MOF treated in the ICU of the RSCS named after acad. V. Vahidov for the period of 2009-2011.

Results: The conducted analysis revealed that in patients with biliary sepsis among the forms of erythrocytes of peripheral blood there dominate pathological transformations with the increase in the number of echinocytes, stomatocytes and multiple irreversible forms of erythrocytes. Subject to the severity of the clinical status of patients, changes in the forms of erythrocytes deteriorate. With the change in the severity of the clinical status there is a tendency to spherocytosis against the background of the reduction of cell volume, which shows the decrease in area of cell surface and a significant reduction in the rigidity of the membrane. The large number of irreversibly changed erythrocytes with a great share of lysed erythrocytes shows the reduction of functions of the reticuloendothelial system, decrease of functions of erythrocytes in the process of oxygenation is an indirect evidence of a significant disturbance of microcirculation.

Conclusions: In patients with MOF and sepsis ratio of normal and pathological forms of erythrocytes significantly changed towards the increase in the number of the latter. Subject to the severity of the clinical status, forms of erythrocytes significantly vary. Thus, the state of the forms of erythrocytes may be a criterion of evaluating the effectiveness of the therapy.

EVALUATION OF THE EFICACY OF ANTIBIOTIC THERAPY IN PATIENTS WITH MULTIPLE ORGAN FAILURE IN ICU.

R.A. IBADOV, Z.A. SHANIEVA, L.G. BAZHENOV, A.S. ARIFJANOV

Republican Specialized Center of Surgery after academician V. Vakhidov, Tashkent, UZBEKISTAN

Multiple organ failure (MOF) may be formed and deepen in different ways, depending on the nature of etiological factor and individual response. Terms of identification and dynamics of formation of individual syndromes is very variable, dysfunctions of various organs can occur in various combinations. MOF is formed and progresses as a result of severe non-specific reaction to injury or infection and is accompanied by the development of insolvency of two or more organs and functional systems. Lethality in the formation of MOF varies from 35 to 75%.

The goal: evaluation of reference protocols for antibiotic prophylaxis and treatment, of methods of monitoring of the effectiveness of ongoing antimicrobial therapy.

In the ICU of abdominal and cardiosurgical profile were treated 478 patients operated in RSCS after V.Vakhidov during 2008-2010. were Blood test for sterility and other biomaterials served as materials for analysis. Were used traditional methods for isolating and identifying of microorganisms, for determining their sensitivity and was performed dynamic control of C-reactive protein (CRP). The level of CRP was detected by VITROS-250 analyzer (G & G, USA), where CRP (N = 0-10 mg / l). For prevention and treatment of bronchopulmonary complications in AVL complex ordinary therapy was supplemented by a new antimicrobial biotechnological domestic product "FarGALS", characterized by a pronounced antibacterial activity. The drug was administered at a dilution of 1:4 with saline, 3-4 times a day for 3-7 days or more in the form of nebulizer therapy.

The frequency of pyoinflammatory complications in patients in 2008 was 2.5%, in 2009 - 1.9%, in 2010 - 2%. Totally were examined 478 samples of wound secretions, of which 204 (42.6%) gave microbial growth and 274 (57.4%) were sterile. Isolated microflora was represented by Gram-negative (77.0%) and Gram-positive organisms (18.2%) and fungi of Candida genus (4,8%). Cultures of microbes were most often planted from blood samples for sterility (33.3%), secretions from trachea (28.0%), drainage tubes (20.3%), the contents of pleural cavity (2.4%) and others (2, 9%). Antibiogram analysis showed that Gram-negative microflora was more resistant than gram-positive. The most active drugs in this case were imipenem (7.0% resistant strains), meropenem (39.0%), polymyxin B (19.0%), cefoperazone / sulbactam (52.0%), amikacin (22.0% ), ofloxacin (44.0%).

Susceptibility of pathogens of bronchopulmonary infections (including multidrug-resistant strains) has shown the activity of FarGALS against all studied microorganisms. Results of in vitro correlated with those in vivo. Clinical improvement of patients in the form of reduced discharge, reduction in body temperature, in SRP level was noted from the 2-3rd day of the treatment. A positive result was registered in all treated patients. It is important to note the high efficiency of FarGALSa compared with conventional therapy (the reduction of antibiotic costs in an average was 30%). In CRP over 70 mg / l de-escalational antibiotic therapy was carried out. The usage of the method of predicting and determining the initial concentration of C-reactive protein contributed to the allocation of risk groups and more targeted antibiotic prophylaxis of nosocomial infections, which would substantially reduce the frequency of the latter (almost 2-times).

Thus, antibiotic prophylaxis of nosocomial infections and antibiotic therapy by a rational consideration of prognostic factors and sensitivity of the leading strains to antibiotics can significantly reduce the incidence of septic complications in ICU.

Date: 2014-12-28; view: 840