THE ROLE OF ACETYLATION PHENOTYPE IN THE ASPECT OF FORECASTING POSTOPERATIVE STATUS OF PATIENTS WITH HEPATIC CIRRHOSIS

R.A. IBADOV, N.R. GIZATULINA, A.H. BABAJANOV, N.A. STRIJKOV

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

UZBEKISTAN

In the mid-20^th century there was preconceived a hypothesis of genetic inheritance of the phenotype subject to the rate of acetylation, where the slow type (FSAc) is a simple Mendelian recessive sign (characterized by a low speed of the process), and fast type (FFAac) - dominant (persons metabolizing test preparations with high speed), that for the majority of them means the presence of parenchymal hepatic lesions and correlates with the morphological and clinico-biochemical assessment of the severity of the condition (Drayer D.E., Reidenberg M.M.).

The aim of the investigation: To determine the dependence of the clinical course in patients with HC on the indicators of the acetylation phenotype

Materials and methods: The results of the examinations in 45 patients with hepatic cirrhosis (HC) of viral etiology, complicated by portal hypertension (PH) were analyzed. In 26 (57.8%) patients morphologically there was found large-node hepatic cirrhosis (LHC), in 19 (42.2%) patients – small-node hepatic cirrhosis (SHC). Acetylating ability of the organism was estimated by Prebsting-Gavrilov method in the modification of Anilova and Tolkachevskaya.

Results: Before the operation, all examined patients, had a significant reduction in the excretion of reopirin metabolites. Before the operation, level of 4 AAP metabolite daily urine of patients with SNC was 3.6 times, and in patients with LHC - 7.36 times lower than control level, N-ac-4AAP in patients with SHC reduced 3 times, and in patients with LHC 5.74 times. Fast type of acetylation was detected in 7 (15.6%), slow type acetylation in 38 (84.4%) patients. In slow phenotype of acetylation significant activation of the cirrhotic process in the liver as compared with fast acetylators (ALT by 74.4% in FSAc, versus 29.5% - in FFAC, total bilirubin by 111.8% as compared to 42%, the level of blood ammonia 247 8% as compared to 62.5%, etc.) was observed.

Conclusion: A comparative analysis of the main biochemical parameters of blood in pre-and postoperative periods in patients with different types of acetylation showed that irrespective of the kind of acetylation, there observed an increase of the basic biochemical indicators of liver. There is a direct relationship of any form HC with immunohistochemical parameters and can become one of the prognostic criteria of complications in the postoperative period.

CURRENT ASPECTS OF PROLONGED ARTIFICIAL PULMONARY VENTILATION IN PATIENTS WITH ACUTE DESTRUCTIVE PANCREATITIS IN POSTOPERATIVE PERIOD

R.A. IBADOV, P.G. KOMIRENKO, A.Sh. ARIFJANOV, N.A. STRIJKOV

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

UZBEKISTAN

The aim of the investigation: to select optimal parameters of APV in patients with acute respiratory failure that occurred in the postoperative period in acute destructive pancreatitis.

Materials and methods: For the period from 2002 to 2010, 46 patients with acute respiratory failure were examined in the emergency department and intensive care unit of the RSCS named after V.Vahidov. Records of intensive care: the first group - 22 patients were applica APV with standard parameters A/C-V (V-10ml/kg, F-12-14 in 1 minute, PEEP-5 cm of water column, Fi02 -0,5 - 0,7, I: E-1: 2. sensitivity - 3-4 cm of water column or 1,5-2 l/min). The second group (24 patients) was applied the pressure control (Pressure Control: pressure of inspiration (Pinsp) - 25-30 cm of water. col., inspiration time - from 0.8-1.1 sec, basic frequency of breaths in the algorithm Assist Control - 12 -14 in 1 minute, PEEP - 10-15 cm of water. col., sensitivity - 3-4 cm of water. col. or 1.5-2 l/min. Concerns: the upper limit of RMV - 10 l / min, the lower limit of RMV - 4 l/min, the upper limit of respiratory rate - 35 in 1 min, the lower limit of the respiratory volume - 3-4 ml/ kg, the lower limit of the pressure of respiratory tracts - 20 cm of water. col., the lower limit of the set PEEP - 7 cm waters. col. The value of FiO2 - 0,4-0,6., providing raO2 60 mm of mercury and saturation of hemoglobin in arterial blood of 90%.).

Assessment criteria: Main – development of complications (change of partial tension of gases in blood, pneumonia, sepsis, sinusitis). Secondary outcomes – survival rate, duration of artificial pulmonary ventilation, length of stay in the intensive care unit.

Results: The partial tension of gases in the blood was higher in the second group. Average length of stay in the intensive care unit in the group pressure mode was applied was lower than in the first group (9 and 16 days resp., P = 0.04). In addition, group in the group A/C-P, serious complications (p = 0.02), pneumonia and sinusitis (p = 0.003;) developed rarely. Survivability constituted 63% in the 1^st APV group and 82% in the second group. In the survived patients of the second group duration of stay under APV (6 and 9 resp., p= 0.006) and duration of hospital stay (9 and 18 days resp., P = 0.002) were less.

Conclusion: The use of APV modes in pressure in patients with acute respiratory failure that occurred in the postoperative period in acute destructive pancreatitis improves gas exchange, and rarely leads to development of complications, with less duration of mechanical ventilation and duration of stay in the intensive care unit.

Date: 2014-12-28; view: 1259