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21МЕДИЦИНСКИЕ НАУКИ
PREDICTION OF POSTOPERATIVE INTRABRUSIVE PURULENT COMPLICATIONS WITH APPENDICULAR PERITONITIS IN CHILDREN Djalolov D.A.1, Shavazi R.N.2, Yusupova Sh.Sh.3
1Djalolov Davlatshokh Abduvokhidovich - medical school
student;
Shavazi Ramiz Nuralievich - medical school student;
Yusupova Shahlo Shavkatovna - medical school student, DEPARTMENT OF PEDIATRIC SURGERY, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: endogenous intoxication accompanies most acute surgical diseases of the abdominal organs in children, including common forms of appendicular peritonitis. Studying the severity of endotoxemia in children with common forms of appendicular peritonitis is of considerable importance, since it allows one to predict the direction of the pathological process and to conduct adequate detoxification therapy. The used complex of examination, along with clinical and instrumental data, allows to control the dynamics of endotoxicosis and on its basis to predict the postoperative period in relation to intra-abdominal purulent complications.
Keywords: peritonitis, multiple organ failure syndrome, immunomodulation, phagocytosis activation.
Endogenous intoxication accompanies most acute surgical diseases of the abdominal organs in children, including common forms of appendicular peritonitis [1-5; 10-14]. Studying the severity of endotoxemia in children with common forms of appendicular peritonitis is of considerable importance, since it allows one to predict the direction of the pathological process and to conduct adequate detoxification therapy [4-9].
For the comparative characteristics of the informativity of various methods, along with the study of the dynamics of leukocyte formula and Leukocyte intoxication index (LII), we
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used the definition of the toxicity of the blood serum of patients in cultured paramecium. According to this method, 138 children aged from 3 to 15 years old were examined with common forms of appendicular peritonitis [12-18]. All studies were performed on 1st, 3rd, and 5th days after surgery. Leukocyte formula was determined by the generally accepted method proposed by Y.Y. Calf Caliph:
(C+2 P+3 U+M y) * (P 1+1 ) — (M+Lym ) * (E+1)
where C - segmented neutrophils; P - stab neutrophils; U -young neutrophils; My - myelocytes; Pl - plasma cells, M -monocytes; Lym - lymphocytes; E - eosinophils. All indicators are expressed as a percentage, with the exception of plasma cells and eosinophils, which are taken in absolute quantities.
The absolute number of eosinophils was calculated by the formula:
„ _ L*E %
Jabs. num. - 1 Q Q %
where L - leukocytes; E - eosinophils. Normal LII in children is 0.6-1.2.
Paramecia (Paramecium caudatum) belong to eukaryotes and exhibit high sensitivity to toxic substances similar to cells of the human body and animals [11]. The serum toxemia of the patients was determined in the culture of paramecium by the quantitative method according to the formula:
T 1 — T2
T - —- * 100%
T
where T is the toxicity of the test serum, unit; T1 - the time of death of 50% of paramecium in the control solution (2% of CaCl2), s .; T2 - time of death of 50% paramecium in serum, s.
A normal indicator of serum toxicity was determined on the control group of 45 practically healthy children of similar age. It ranges from 24 to 32 units, an average of 28 ± 0.5 units. The leukocyte formula in the observed patients was characterized by a neutrophilic-eosinopenic type, manifested by pronounced leukocytosis, left-shifting neutrophilia, lympho- and monocytopenia, hypo- or aneosiophilia. In 82% of children with an unfavorable postoperative period, leukocytosis (12-25 * 109 / l) was observed with a shift to the left formula and a neutrophil:
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leukocyte ratio from 5 to 12, accelerated erythrocyte sedimentation rate (30-50 mm / h); the guilt of patients - toxigenic granularity of neutrophils (30% or more). However, in every fifth patient, the blood reaction to inflammation was absent or was even reduced, which is probably due to the inhibition of hematopoiesis under the influence of intoxication.
The dynamics of LII and paramecine test indicators suggests that in all patients with common forms of peritonitis, serum toxicity is dramatically increased. In patients with a favorable postoperative course, the parameter of the parametric test consistently decreased from 57.9 ± 1.9 units; on the first day after surgery up to 48.2 ± 1.72 units. on the third day and 40.8 ± 1.83 units - on the fifth (P <0.001). On the contrary, with such complications as intra-abdominal abscess or continuing postoperative peritonitis, the toxicity of patients' blood serum remained at a high level. [4]: respectively 59.2 ± 1.68; (60.7 ± 1.8 and 51.0 ± 1.78 units. With a favorable course of the postoperative period, along with the positive dynamics of clinical data, there was a significant decline in LII and paramecine test scores (P <0.01).
Research results show that the dynamics of indicators of leukoformula, LII and serum toxicity test can be used as objective criteria for the intensity of toxemia and the course of the inflammatory process and the abdominal cavity, the latter being the most informative.
Conclusions. The used complex of examination, along with clinical and instrumental data, allows to control the dynamics of endotoxicosis and on its basis to predict the postoperative period in relation to intra-abdominal purulent complications.
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