FEATURES OF COMPLEX PREVENTION AND TREATMENT OF LIVER ENCEPHALOPATHY AT PATIENTS WITH LIVER CIRRHOSIS AT STAGES OF SURGICAL TREATMENT

R.A. IBADOV, A.H. BABAJANOV

Republican Specialized Centre of Surgery named after acad. V. Vahidov,

Tashkent, UZBEKISTAN

The purpose of research: efficiency rating of complex application of biophysical and pharmacological means in treatment of liver encephalopathy at stages of surgical intervention at the patients with liver cirrhosis. The results of investigation and treatment of patients with liver cirrhosis taking place in RSCS for the period 2000-2003 have served as the base of research. The complex therapy included medical treatment in a combination with biophysical method. Preference was given to Hepa-Merz (L-ornitin - L-aspartat) produced by Merz(Germany). The biophysical method of treatment is presented by hyperbaric oxigenation (HBO). In group of the patients after porto-systemic bypass, which are included Hepa-Merz + HBO in complex treatment in early postoperative period, the obvious tendency to cholemin and blood enzymes reduction was marked after 5-6 courses. The complete stabilization of biochemical parameters of blood has come on 9-11 courses. It was clinically expressed in improvement of a general condition of the patients, disappeared jaundice, skin itchiness, and signs of asteno-neurotic and dyspeptic disturbances have almost completely disappeared after 6-7 sessions. Concentration decrease of ammonia at morning hunger occurred alongside with clinical data improvement: on 53 % in comparison with initial parameters at LE II stage, on 39 % and on 25 % at LE III and IV stages respectively. The ammonia level reduced up to normal values at the patients with an easy degree of LE. Also, the reduction of parameters of ammonia difference was marked at all investigated LE stages, which testified increase of tolerance to a serum.

Thus, the inclusion of Hepa-Merz + HBO in a complex of rehabilitative measures at the patients with liver cirrhosis at porto-systemic bypass stages is characterized not only by increasing of neutralization function of liver, enhancing of blood circulation and local hepatic circulationа, restoration of exchange processes with liquidation of hypoxic vicious circle, but also with "protection" of CNS from mental disturbances being a consequence of metabolic intoxication.

MONITORING OF THE FORMS OF ERYTHROCYTES IN THE DYNAMICS OF INTENSIVE THERAPY IN PATIENTS WITH HEPATIC CIRRHOSIS

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

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

UZBEKISTAN

Erythrocyte membrane is highly sensitive to changes in the concentration of toxic substances appearing in the blood in various diseases. There is a large group of substances that lead to stomatocytary or echinocytary transformation of cells. It is known that bile acids cause echinocytary transformation. After removal of substances causing or echinocytory stamatotsitarnuyu transformation erythrocytes regain discoid shape. This property can be a criterion for the evaluation the effectiveness of the therapy.

Objective: To examine the state of forms of erythrocytes during the intensive therapy in patients with hepatic cirrhosis (HC).

Material and methods: Capillary blood on rapid method of “thick blood” (EMTK) - Patent RUZ № DGU 01195, was studied in 25 patients receiving intensive therapy with a diagnosis of HC, PH, esophageal varices of 3^rd stage., complicated with bleeding.

Results: Analysis of obtained data showed that in HC peripheral blood reacts by changing percentage of erythrocytes with normal and abnormal form. Conducted estimates have shown that after bleeding in patients with HC, PH, esophageal varices of 3^rd stage, a decrease of dyscocytes up to65% and an increase in the number of pathological forms by 14% is observed. In severe forms of course the number of dyscocytes reduces. In a stable course of HC the content of dyscocytes is usually higher than in exacerbation. Clear signs of poikilocytosis and anisocytosis play an important positive role in the organization of blood clots during the bleeding of varices. On the other hand, the shape of an erythrocyte is a mirror of its functional state, and the progression of pathological transformations against the background of decreased hemoglobin and hematocrit further aggravates the already impaired oxygen-blood properties, and explains the increase in the degree of hypoxia and severity of clinical status.

Conclusions: It was found that patients with HC, PH, esophageal varices, there is a significant change in variceal ratio of normal to abnormal forms of erythrocytes towards expressed predominance of the latter. Intensive care leads to restoration of the ratio of erythrocytes of peripheral blood and a significant reduction in the number of pathological and irreversible forms.

Date: 2014-12-28; view: 1006