A method for predicting extraperitoneal complications of widespread peritonitis

 

(57) Abstract:

The invention relates to medicine, in particular to anesthesiology and critical care medicine. Patients examine the contents of lactoferrin in the serum and peritoneal exudate on the first day of the postoperative period. While declines in serum levels of less than 1000 ng/ml and less exudate 3500 ng/ml predict the likelihood of extraperitoneal complications. The method is simple and easy to perform and allows early to predict the development extraperitoneal complications.

The invention relates to medicine, in particular to anesthesiology and critical care medicine.

Peritonitis and its common form is the most serious option surgical infection, which can worsen symptoms of sepsis and multiple organ failure. First of all organ complications that accompany a period of widespread peritonitis are complications of the lungs, in particular infectious-inflammatory diseases (acute pneumonia, endobronchitis). The second place is occupied extraperitoneal complications of the kidneys. At this point the t of clear criteria which would characterize the signs of the disease at early stages (before clinical manifestations). Thus, it remains highly relevant approach to identify complications at the preclinical level prior to the onset of clinical signs of pneumonia and endobronchitis.

A known method for predicting the development of extracranial infectious complications and outcome of acute period of traumatic disease of the brain by hematological tests: leukocyte index of intoxication, neutrophile-leukocyte index Krebs, counting the absolute number of lymphocytes, which were analyzed in comparison with the patient assessment of level of consciousness (BOS). During the analysis, in addition to the graphic pattern and the magnitude relation of R2was calculated by the formula this regard, expressed in charts (Okulov C. M. “Clinical and diagnostic value of changes in indicators in the acute period in isolated brain damage”. The dissertation on competition of a scientific degree of the candidate of med. of Sciences, St. Petersburg, 1997).

The disadvantage of this method are lability leukocyte index of intoxication, the possibility of developing infectious complications in normal and reduced share is.

A known method for predicting complications in patients with acute pancreatitis. The method consists in the evaluation of pH inside the mucous membrane of the stomach and tension of carbon dioxide in the patient's blood, when determining pH less 7,32 made a conclusion about NUTRISYSTEM acidosis and possible adverse acute pancreatitis [Kon E. M., Cherkasov C. A., Samartsev C. A., Cohn C. E. a Method for predicting complications and fatal outcome in patients with acute pancreatitis. Patent # 216184, M CL 7 G 01 N 33/84, bull. No. 1 from 10.01.2001].

The disadvantage of this method is the difficulty in carrying out the method (the need to place a separate probe into the stomach), the distortion results when using this method in terms of the syndrome of enteral insufficiency (long stagnation in the stomach), the difficulty in the interpretation of data on the pH inside of the gastric mucosa under conditions of endotoxic shock and reduced blood flow in the mucosa, which often complicates the course of acute abdominal diseases.

Closest to the claimed is a method for predicting extracranial infectious complications, and assess the adequacy of treatment in post-traumatic period, for calsim blood test is proposed to investigate the phagocytic activity, Nst-test, the peroxidase activity of monocytes and neutrophils. Sign threats of infectious complications is the functional activation of monocytes with simultaneous inhibition of absorption and digestive ability of macrophages. (Gizatulin M. I. “Features reactivity phagocytic system in the acute period of isolated brain damage”. The dissertation on competition of a scientific degree of the candidate of med. Sciences. Leningrad, 1990).

The disadvantage of this method is the complexity of the analysis techniques activity of monocytes, the possible effects of medical procedures on the effectiveness of the test (load antibiotic endogenous toxicosis), and the absence of data on the impact of resorption of the peritoneum components of endogenous intoxication as one of the main factors in the development extraperitoneal complications.

The objective of the present invention consists in predicting extraperitoneal complications of widespread peritonitis by determining the content of lactoferrin (LF) in the serum and peritoneal exudate on the first day of the postoperative period. On this basis, the optimum method of treatment aimed at possible prophylaxis extraperitoneal investigate the serum and peritoneal exudate on the LF content in the first day after surgery and simultaneous decline in the serum of less than 1000 ng/ml and less exudate 3500 ng/ml predict the likelihood of extraperitoneal complications that requires additional therapy: strengthening antibacterial component therapy, joining active methods of detoxification for extra protection from systemic infection, the remedial fibrobronchoscopy.

The novelty of the method:

1. The control content of the LF during the first days after surgery.

2. The LF in the serum of less than 1000 ng/ml indicates inadequate nonspecific resistance of macrophages blood and possible generalization of the microflora causing peritonitis, abdominal cavity when it is released into the systemic circulation.

3. The LF of the exudate is less than 3500 ng/ml predicts the ineffectiveness of the protective barrier of the peritoneum as a factor counteracting the generalization of microorganisms.

Control of the concentration of lactoferrin is due to the fact that in the development extraperitoneal complications of peritonitis pays great attention to the dysfunction of the nonspecific activity of neutrophils in the blood, and on the border between the peritoneum and blood. Timely early diagnosis of these disorders is very important to assign adequate correction and restoration of normal function, n is the RNO and early to diagnose the development extraperitoneal complications depending on the status of peritoneal macrophages and neutrophils blood in the postoperative period and promptly appoint a corrective treatment to avoid adverse disease outcome.

The method consists in the following: blood and peritoneal to study the LF content produced in the first day after surgery in patients with acute widespread peritonitis.

For the determination of lactoferrin using venous blood and peritoneal exudate. Immediately after exposee biological fluid volume of 1 ml centrifugeuse. In the following were performed enzyme-linked immunosorbent assay of serum content of lactoferrin and solid-phase immunoelectrophoresis for the determination of LF in peritoneal exudates.

The control content of the LF during the first days after surgery due to the fact that, due to increased permeability of the peritoneum for microbial toxins and inefficient secretion by macrophages possible generalization of microbial toxins and their systemic effect - development extraperitoneal complications (pneumonia, traheobronhity, toxic encephalopathy, renal failure).

The LF in the serum of less than 1000 ng/ml indicates inadequate nonspecific resistance of macrophages blood and possible generalization of the microflora, the date of 3500 ng/ml predicts the ineffectiveness of the protective barrier of the peritoneum as a factor opposing generalization of microorganisms. Reduced rate LF does not allow neutrophils to ensure adequate antimicrobial response.

Example 1.

Patient C., no history 47, was hospitalized in the Department of emergency surgery of the city clinical hospital №1 06.06.2002 g with a diagnosis of penetrating wound of the abdomen with damage to the colon, widespread purulent peritonitis. In case of emergency surgery, surgery: laparotomy and closure of the damage to the intestine, laparostomy. When repeated readjustment of laparostomy the LF of (blood taken from a vein on the first day of the postoperative period, the exudate obtained during surgery) on the first day in the serum was 805 ng/ml in peritoneal exudate 2110 ng/ml Interpreted this condition as inefficient system of polymorphonuclear leukocytes on combating generalization of flora from the abdominal cavity. On the third day was fixed acute right-sided pneumonia as extra-peritoneal complication of peritonitis

Example 2.

Patient K., no history 388 hospitalized 03.03.2002 in the Department of emergency surgery of the city clinical hospital №1 with a diagnosis of gyrovague, drainage stuffing bags and abdominal cavity. The LF of the blood serum (the fence in the postoperative period) amounted to 790 ng/ml, the LF of peritoneal exudate (analysis taken into surgery to wash the abdominal cavity) 803 ng/ml On the second day the patient experiencing the effects of acute pneumonia, tracheobronchitis. The diagnosis is confirmed by x-ray picture of the chest (infiltration of the right lung), band shift of neutrophils, obtaining purulent sputum when the bailouts of the tracheobronchial tree). The patient in addition to traditional methods of therapy initiated intensive activities: conducted sessions fibrobronchoscopy, enhanced antibacterial therapy - Tienam 500 mg/3 times a day and conducted active methods of detoxification. As a result of combined treatment the patient's condition has stabilized, complications cropped, which allowed us to conduct a series of sanitation operations for optimal performance.

Thus, patients with the widespread peritonitis definition of LF content in the blood and peritoneal exudate allows to predict the development extraperitoneal complications common periodinane extraperitoneal complications of widespread peritonitis by studies of biological fluids, characterized in that the patients investigated the content of lactoferrin in the serum and peritoneal exudate on the first day of the postoperative period and during the simultaneous decline in the serum of less than 1000 ng/ml and less exudate 3500 ng/ml predict the likelihood of extraperitoneal complications.



 

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FIELD: medicine, biochemistry.

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FIELD: medicine.

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1 tbl

FIELD: medicine.

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EFFECT: high quality of estimation.

2 tbl

FIELD: medicine.

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5 tbl

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3 ex

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1 dwg, 1 tbl

FIELD: medicine.

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EFFECT: high accuracy and reliability of diagnosis.

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